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UNITED STATES OF AMERICA. 



THIRTY YEARS OF FEMALE LIFE. 

A TEEATISE 

ON THE 



INCIDENT TO THIS PERIOD, 

WITH THEIR 

CAUSES, SYMPTOMS AKD TREATMENT ; 

INCLUDING THE 

THEORY OF CONCEPTION, 

AND THE 

SYMPTOMS OF PREGNANCY. 



BY L. H. LINES, M. D. 



FOE POPTJLAR USE. ILLXTSTRATED. 



NEW YORK : V'" ' ^"^K. 

PRINTED BY W. E. HILTON, 11 SPRUCfe^ STREET. ^. J 

1863. ' *"^--^-^^^ %^jy 



Entered according to Act of Congress, in the year 1862, 
BY L. H. LINES, M. D., 
in the Clerk's OflBce of the District Court of the United States for 
the Southern District of New York. 



Z I % "^^ 



TO WOMAN, 

WHO, WITH PATIENT SUFFERING 

AND TENDER CARE WATCHES OYER OUR INFANTILE 

HELPLESSNESS, THIS LITTLE VOLIBIE IS 

RESPECTFULLY DEDICATED BY 

THE AUTHOR. 



THIRTY TEARS OF FEMALE LIFE. 



For ages past the practice of medicine has been 
shrouded in mystery, and physicians generally, at the 
present day, imitate their ancient brethren in with- 
holding from the people that information they alone 
can give. There are, however, a few — too few — hon- 
orable exceptions ; and among them we can, with 
pleasure, refer to Dr. E. J. Tilt, an eminent Euro- 
pean physician, and of our own country. Prof. Moigs, 
of Philadelphia, whose candor is only equaled by 
his skill in the healing art. Dr. Meigs says, in re- 
gard to this subject, that " our fault consists in the 
concealment within our own breasts of a great amount 
of communicable information, which it is our duty 
to pour forth into the public mind, and which we 
should certainly diffuse, spread abroad, and make 
vulgar or common, but for our clerkly or clergyable 
pride. The Doctors have an idea that their know- 
ledge cannot be imparted to the world, and that it 
is better in fact that the world should not be pos- 
sessed of such recondite information as theirs." And 
in another passage, '' I say, then, it is our stupidity 
and our remissness that work evil to the people, 
redounding to our own hurt also ; for there is no 
person, endowed with a good share of common 
sense, to whom we could not address, through that 



6 THIRTY YEARS OF FEMALE LIFE. 

common sense, a reasonable and plain statement of 
the facts of his case, the probabilities as to its course, 
duration and end ; with an enumeration of the safest, 
most convenient and certain processes of its cure/' 

'' Imagine such a person, well informed, and you 
have the idea of a patient the most docile, the most 
exact in therapeutic and hygienic obedience ; the 
most confiding in your skill, and the most grateful 
for your intervention in his behalf. Would that 
all our brethren in this land might adopt views 
like these. With their united force of intellect, 
character, beneficence and social station, it would 
bo but a short time ere the diminished head of 
charlatanism, under whatever disguise, would be 
found only to lift itself up among the most ignorant 
and abject portions of the population, instead of 
riding, as it does to-day, with chariots and with 
horsemen, a shame to the intelligence of the age, 
and a perpetual eye-sore to the lover of truth and 
contemner of every species of imposture. Let us 
explain ourselves, then, to the people, whose cry is, 
* what do you mean ? What do you mean' ?" — Meigs 
on Diseases of Women page 36 and 42. 

This reserve on the part of physicians is carried 
so far that it is often the case that instead of getting 
any information as to the nature of the remedies 
the patient is swallowing, hour after hour, and day 
after day, even the name of the disease is not com- 
municated. '' What does the doctor say the disease 
is ?" a friend inquires of the patient, or some mem- 
ber of the family. '' He has not told us,'' is the 



THIRTY YEARS OF FEMALE LIFE. 7 

reply ; they are sick, and must take whatever the 
physician orders, and ask no questions." How dif- 
ferent the course pursued by the Empyric, who, 
although ignorant even of the first principles of med- 
ical science, has managed to pick up a smattering of 
medical terms with which he expatiates, in his jargon, 
on the cause and symptoms of disease and the won- 
derful effect of the remedies he uses. 

The people being uninformed in regard to these 
things by physicians capable of giving correct in- 
formation, they receive the explanations imparted 
to them by the charlatan as correct teachings, and 
regard him, in too many instances, as a very learned 
man, when his explanations have been merely aeon- 
fused and jumbled peversion of facts. 

It is not the fault of the people that they are ig- 
norant of the best mode of preserving their health, 
the effect of symptoms and nature of remedies ne- 
cessary to cure them when sick ; on the contrary, 
they are anxious to obtain information on these 
subjects : hence it is too often the case that the in- 
telligent physician is set aside because he has not 
imparted to them that information they are enti- 
tled to receive ; and the empyric who talks with 
them on these subjects, as they think learnedly, 
is installed in his place because they are not pre- 
pared to discriminate between the learned physi- 
cian and the ignorant pretender. Physicians are the 
conservators of the public health ; the people look 
to them for advice, and go to them for counsel in 
their hour of aflSiction, and when prostrated on the 



8 THIRTY YEARS OF FEMALE LIFE. 

bed of sickness, hope for a restoration to health 
•through their skill, in the use of means. Their sphere 
of usefulness is not alone in administering to the re- 
quirements ot the sick, but in communicating from 
their rich store of knowledge, correct information in 
regard to the cause of disease, the nature of the treat- 
ment, the best mode of preserving the health, the 
importance of attending to the first appearance of 
abnormal action, and the serious consequences of 
neglecting apparently trifling symptoms. When 
they do this, the true physician will occupy his true 
position ; the people will be capable of discrimina- 
ting between true and false explanations, and pro- 
tected from the extortions of the unprincipled im- 
postor. Believing as we do, that much good can 
be done by imparting correct information in regard 
to the causes, symptoms, and treatment of diseases 
in all their varied forms, we shall pursue such a course 
in the following chapters of this treatise on the dis- 
eases of females. 

There is certainly great need of something being 
done to improve the physical condition of women 
and mitigate their sufferings ; and in what better 
way can this be accomplished than by imparting to 
them correct information in regard to the causes, 
and symptoms of diseases with which so many of 
them are afflicted at the present day. If they know 
the cause and the effect of symptoms, they will see 
the importance of attending to slight deviations 
from a healthy condition, and not wait until the 
disease has made such fearful havoc with the vital 



THIRTY YEARS OP FEMALE LIFE. 9 

functions that a restoration to health, when they do 
apply for relief, is sometimes impossible. 

Many of the complaints so common amongst fe- 
males at the present day are apparently of a trivial 
nature at their commencement ; some slight devia- 
tion, at first, of the natural functions of the organism, 
which, by being neglected, assume a serious charac- 
ter ; it is in this way that a life of sulBfering frequent- 
ly commences. The importance of attending to the 
first appearance of abnormal action cannot be too 
strongly impressed upon the minds of women, who, 
in many cases, suffer a disease to gain a firm hold 
upon the system, thinking that the symptoms are 
only such as all women experience, and make no 
complaint. 

With the treatment before them made plain and 
comprehensive, and, at the same time, such as a ju- 
dicious physician would recommend, they will be 
able, by a timely recourse to the proper remedies, to 
improve their health and prevent much suffering ; 
or if the complaint has assumed such a form that it 
would not be prudent for them to take it in hand, 
they will see the necessity of consulting a physician 
capable of treating the case successfully. 

The want of information amongst females in re- 
gard to their diseases works evil to themselves and 
the profession ; to themselves, in placing too light 
an estimate on the first symptoms of ill health, which, 
in too many instances, permits a disease, with all its 
attendant suffering, to run on until it is very difficult 
and sometimes impossible to cure. : to the profes- 



10 THIRTY YEARS OF FEMALE LIFE. 

sion, in placing confidence in ignorant pretenders, 
who cannot understand their complaints or know any- 
thing of the proper course of treatment required in 
their case. By carefully studying the following 
pages they will understand what is necessary to be 
done, even if the case is beyond their reach, and the 
importance of faithfully attending to the use of re- 
medies to effect a cure. 

CHAPTER II. 

THE FEMALE ORGANS. 

There is, probably, no subject connected with me- 
dical practice of more importance, or invested with 
greater interest, than the diseases of females. In 
this treatise on the diseases of the female organism, 
I shall endeavor to present the subject in a plain 
yet systematic form, avoiding, or explaining as much 
as possible, professional terms, in order that all may 
be able to comprehend tl^e meaning. In investiga- 
ting any subject, there must be a starting point, and 
in order to obtain a knowledge of those organs des- 
tined to play so important a part in female life, it 
will be necessary to give a description of their lo- 
cation, and relation to other parts of the system, be- 
ginning with that part of the body called the pelvis. 
This is a large, bony cavity composed of four bones ; 
two constituting the back part of the pelvis are 
called the sacrum and coccyx, and are a continuation 
of the spine. The other two bones of the pelvis are 



THIRTY YEAHS OF FEMALE LIFE. 



11 



situated at the sides and in front ; these are the hip 
bones, to which the thigh bones are attached. The 
four bones of the pelvis are so arranged and united 
as to form a basin or cavity, open at the upper and 
lower portion, containing some portions of the small 
intestines, the bladder, uterus (with its nerves, blood 
vessels and appendages), the rectum, and important 
blood vessels and nerves distributed to the lower 
extremities. The uterus, or womb, is situated be- 




A ThQ Spine. B Rectum. C Womb. D Bladder. E Vagina.* 

tween the bladder and rectum ; the vagina or front 
passage is a somewhat curved canal about five or six 
inches long, leading to the womb. In the virgin 
state the vagina is generally closed, or nearly so, by 
a thin membrane called the hymen, which is destroy- 



12 THIRTY YEARS OF FEMALE LIFE. 

ed by the first act of sexual intercourse after marri- 
age, producing a show of blood, or it may be so firm 
and unyielding that considerable hemorrhage occurs, 
and severe pain is experienced. Although this mem- 
brane is considered a mark of virginity, yet its ab- 
sence does not prove incontinence, as it may be de- 
stroyed by disease, by professional examinations of 
the parts, or it may not exist at all, as has been 
proved, soon after birth, in many instances. The 
form of the womb is pear shaped, considerably flat- 
tened from front to back ; from two and a half to 
three inches long, and about one inch and a half 
broad across the upper portion ; the lower part or 
neck of the womb is much smaller than the upper 
portion, being hardly one inch in thickness. The 
OS uteri, or mouth of the womb, is a small opening in 
the neck of the wjomb through which the monthly 
periods flow. In some cases the mouth of the womb, 
or the passage through the neck of the organ, is 
closed by a membrane or adhesion, which prevents 
the monthly flow from escaping. Before impregna- 
tion the weight of the womb is about one ounce. 
It is abundantly supplied with nerves and blood ves- 
sels. The appendages of the womb are the round 
and broad ligaments, the fallopian tubes and ovaries. 
The broad ligaments are attached to the upper por- 
tion of the uterus, and are a continuation of the serous 
membrane, which lines the cavity of the abdomen. 
The fallopian tubes are situated one on each side of 
the womb, at its upper portion, enclosed in the 
broad ligaments, and are four or five inches in length, 



THIRTY YEARS OF FEMALE LIFE. 13 

terminating in a fringe like appendage. The ovaries 
are two oblong oval bodies, somewhat flattened, 
about one inch in length and half an inch in breadth 
and thickness, situated one on each side of the womb, 
a little more than an inch from that organ, partially 
enveloped in the broad ligaments, and slightly con- 
nected with the fimbriated extremities of the fallo- 
pian tubes. They are supplied with nerves and 
blood vessels, and their structure consists of nume- 
rous vesicles imbedded in a soft fibrous structure. 
From between the folds of the broad ligaments, a lit- 
tle in front, and below the fallopian tubes, the round 
ligaments arise ; they branch off from the womb, and 
pass out of the pelvis near the groins, where they 
branch off and are inserted into the tissue of the 
external labia and mons veneris. The female gen- 
erative organs are divided into internal and exter- 
nal ; the former are contained within the pelvis, and 
have been described ; the external organs are the 
mons veneris, labia majora, labia minora, clitoris, 
meatus urinarius and hymen. As previously stated? 
the entrance to the vagina or front passage is usual- 
ly closed in the virgin state, by a delicate membrane 
called the hymen, in which there is a small opening 
for the passage of the monthly flow. The labia ma- 
jora and labia minora are the larger and smaller lips^ 
closing the external opening or front passage ; the 
external surface of the labia majora are covered with 
hair. The mon^ veneris, or mont de v^nus, is a more 
or less projecting eminence at the lower part of the 
abdomen, which like the labia majora is, at puberty, 



14 THIRTY YEARS OF FEMALE LIFE. 

also covered with hair. On separating the labia or 
lips of the vulva, the orifice of the urinary passage 
is brought to view. The clitoris is a small elongated 
body, situated a little above the orifice of the urina- 
ry passage. It is the clitoris,when greatly enlarged 
by diseased action, that has given rise to the term 
hermaphrodite. 

CHAPTER III. 

MENSTRUATION. 

At the age of puberty, the great drama of 
female life is ushered in by the action of 
the internal organs of generation, producing the 
monthly flow, proving that she is capable of fulfil- 
ling one of nature's greatest gifts — the propagation 
of the species ; and like the change of life at a more 
advanced age, the commencement of menstruation 
is an important and critical period for the young fe- 
male. " The age of puberty is distinguished by a 
series of changes as remarkable in the effect which 
they produce upon the character, morally and phy- 
sically, as their operations are important to the ani- 
mal economy. They are more or less strongly 
marked in every case ; and from the circumstance of 
this period having been at all times regarded as one 
pre-eminently favorable to the propagation of new 
forms of disease, or the development of those, the 
latent germs of which already exist, it is usually an- 
ticipated with the greatest anxiety. Before the 
first appearance of the menses, and after their ces- 



THIRTY YEARS OF FEMALE LIFE. 15 

sation, the female constitution differs but slightly 
from that of the male in its susceptibility to morbid 
action, or in the character of the disease by which 
it may become affected. On the approach of puberty, 
the body undergoes a notable alteration in its growth 
and development. The stature in the majority, 
though not in all instances, is fully attained by the 
time the crisis is accomplished ; but the change 
exhibited in its other proportions, is especially 
striking. The chest becomes full and expanded, 
the breasts are more prominent, the nipples percep- 
tibly enlarged and irritable, and the neck, throat, 
limbs and features are more plump and rounded. 
The growth of hair and the cutaneous tint partici- 
pate in the general metamorphosis ; and the voice 
acquires a full, mellow and more sonorous intona- 
tion. It is now that the female figure acquires that 
exquisite elegance of symmetry, the complexion its 
peculiar bloom of health and beauty, and each fea- 
ture that speaking brilliancy of an expanded intel- 
lect, often joined with an artless simplicity and an 
indescribable gracefulness of action, which, of all 
nature's productions, are to be found united in wo- 
man alone. Evidences of these changes are often 
detected many months — sometimes years — before 
puberty ; but more commonly they occupy a much 
shorter period, the lank figure and unrestrained 
movements of the girl being changed, in the space 
of a few months, into the finished form and reserved 
manners of conscious womanhood.^'* 

♦Whitehead on Abortion and Sterility, page 34. 



16 THIRTY YEARS OF FEMALE LIFE. 

" Previous to the first appearance of the menses 
and during their flow, the complexion, especially in 
lymphatic or bilious subjects, sometimes assume 
a sallow or greenish tinge, and the eyes are surround- 
ed by a dark areola ; these appearances, which 
are noticable in a greater or less degree ever after- 
wards, are 'generally the result of functional dif- 
ficulty at the commencement of menstruation, and 
for the most part are associated with a languid 
circulation through the veins, and a low nervous 
power. The skin is particularly liable, at this crisis, 
to eruptive disease, coming on with the other indi- 
cations of puberty, and not unfrequently continuing 
to disfigure the features for several years. The 
boil and the irritable pimple, are the most common 
of these affections." "The manner of the individual 
is perceptibly altered ; she evinces a disinclination 
to share in her accustomed enjoyments and exercises ; 
she is languid and listless, often reserved and 
fretful ; the appetite is capricious, the secretions 
vitiated, the bowels irregular, the sleep disturbed 
and unrefreshing. Pain in the back and head, and 
sense of fulness and weight of the abdomen super- 
vene ; accompanied, not unfrequently, with heat, 
and a troublesome irritation about the lower part 
of the person. Often these symptoms are but slight 
and transitory, being soon relieved by the vaginal 
discharge, which after continuing a few days, sub- 
sides, and the health is speedily restored. The dis- 
charge does not always, at first, presents the true char- 
acter of menstrual blood, being at times merely a thin 



THIETY YEARS OF FEMALE LIFE. 17 

mucous or serous fluid, transparent, or but slightly 
colored, assuming at each succeeding period more 
of the normal appearance, which it acquires only 
after several repetitions. It is not always, however, 
that this desirable end is so opportunely accomplish- 
ed ; on the contrary, it may be long protracted, and 
symptoms of disease become more decidedly manifest 
Excessive languor, drowsiness, violent pain in the 
head, along the spine, and around the lower region 
of the abdomen and pelvis, with alternate rigors 
and feverish reaction, clearly indicate a loss of bal- 
ance in the circulatory and nervous systems, which, 
if not timely remedied, must inevitably lead to in- 
jurious consequences. These symptoms are occa- 
sionally aggravated by exposure to a cold or damp 
atmosphere, over exertion, anxiety, disappointment, 
and other causes ; and mischief of a serious, often 
of a lasting nature is the result. Such a consumma- 
tion is the more to be dreaded if the individual has 
previously suffered under organic inflammatory af- 
fections, or if she inherits a tendency to maladies 
of a specific nature. These disturbances may exist 
for months or years before menstruation can be 
brought about, and they not unfrequently termi- 
nate in fatal organic diseases.''^ 

The phenomena of menstruation, which has been 
so graphically described by the author just quoted, 
may be perverted, by an imprudent course pur- 
sued by the girl, not knowing how to take proper 
care of herself at this critical period ; " who, taken 

*"WTiitebead on Abortion, and Sterility, page 35. 



18 THIRTY YEARS OF FEMALE LIFE. 

by surprise, is either in total ignorance or is in- 
sufficiently prepared to adopt such means as will 
favor its establishment, and ensure its due reappear- 
ance. If mothers, independently of professional as- 
sistance are, from ignorance, unprepared to give 
their daughters advice at this period, or if they 
withhold it from mistaken notions of delicacy, the 
most serious consequences may ensue. It may be 
said, that it is only in the lower classes that girls 
are kept in darkness relative to what is of so much 
importance ; but this is by no means the case. The 
same bad management equally prevails in the mid- 
dle and higher classes of society. Girls in affluent 
circumstances and well educated, in other respects, 
are, I know, often taken by surprise at the first ap- 
pearance of this function. Mothers, who in other 
respects act judiciously, will not condescend so far 
to bow down to the infirmities of their nature, as 
to give the necessary advice to their daughters."^ 
They need advice from some one, and^who can 
impart it with greater propriety than a mother ? 
There is, also, an important duty devolving upon 
physicians in this matter. In attending to the busi- 
ness of their profession, they should impress upon 
mothers the importance of speaking freely with 
their girls in regard to the important function 
of menstruation, and also to impart such information 
to the mother as she may require on the subject, 
as many a one, anxious about the welfare of her 
child, has resorted to means to assist nature, because 

♦Tilt on Health of Women, page 21. 



THIRTY YEARS OF FEMALE LIFE. 19 

the girl was old enough, yet had not become regu- 
lar, without taking into consideration a more impor- 
tant fact than her age, that of general health and 
development. "We too often call to mind, with 
bitter recollections, the fate of a most amiable, in- 
teresting young creature, for whom we were request- 
ed to prescribe for the expected menses, but who 
had not one mark that could justify an interference, 
more especially as she was in perfectly good health. 
* She was fifteen ; it was time^ ; and this was all that 
could be urged by the mother in favor of an attempt 
*to bring down the courses.' We relied too much 
on the good sense of her anxious parent, and freely 
explained ourselves to her. She left us apparently 
satisfied with our reasoning, and we heard nothing 
more of the child for six months, when, on being 
suddenly summoned to attend her, we found her 
throwing up blood in considerable quantities from 
the lungs, of which disease she died in a few days. 
The distressed mother told us, that though she ap- 
peared satisfied with what we had said, she felt con- 
vinced that we were wrong, and that her daughter's 
health required the immediate establishment of the 
menstrual evacuation. With this view, she deter 
mined upon trying a quack medicine of some celeb- 
rity in similar cases. She gave it according to the 
directions, and in a few days her daughter became 
feverish, lost her appetite, and sufi'ered from nausea ; 
her strength gradually diminished, and she was soon 
confined to her bed. The mother called in the 
quack doctor, who encouraged her to preserve, by 



20 THIRTY YEARS OF FEMALE LIFE. 

telling her the fever was an effort of nature for the 
end proposed. She persevered, and in a few days 
lost an only and lovely daughter. We examined 
the medicine which had been administered, and it 
proved to be oil of Savin.'' * 

Because a girl has reached her fifteenth or six- 
teenth year without becoming regular, does not prove 
that she requires active cathartics, or forcing med- 
icines like savin, tansy, and others of this class. 
The age of the girl is of little value in pointing out 
the course of treatment necessary to be pursued, 
this must be determined by inquiring into her gen- 
eral health. If she is in a weak, debilitated condi- 
tion, the countenance pale, bowels irregular, appe- 
tite variable, and the blood in an impoverished con- 
dition, which is generally the case in tardy menstru- 
ation, every effort to bring on the show by forcing 
medicines will only do her harm ; build up the weak 
organism with iron, and other tonics, healthful exer- 
cise and generous diet, with gentle cathartics to 
regulate the bowels, and menstruation will follow, 
if the proper organs exist for performing this func- 
tion ; or if they have become properly developed. 
If the general health is good, it is rarely necessary 
to interfere further than to insist on plenty of out 
door exercise ; and if the bowels are constipated, gen- 
tle laxatives. A female menstruates because the 
proper organs have reached that state of develop- 
ment which enables them to perform this function ; 
also because the system is in a condition to spare 

♦Lewees Midwifery , page 133. 



THIRTY YEARS OF FEMALE LIFE. 21 

this monthly loss of blood from the circulation, not 
only without injury, but with positive benefit. What 
folly then, when one or both of these conditions are 
defective, to administer forcing medicines while this 
abnormal condition continues. The age at which 
a female first menstruates differs considerably in the 
same latitude as a general rule, however, in this 
country, it first makes its appearance about the fif- 
teenth year. In countries much north of this, or 
far south, it is said to commence much later in life, 
or earlier, as the individual may be located north 
or south. Anomalous cases exist here, of menstru- 
ation occurring much before the usual time. Sev- 
eral instances are recorded of the show commen- 
cing before the fourth year. One in New Orleans, 
of a girl born with the marks of puberty and men- 
struated at three years of age : another occurred 
in Kentucky ; in this instance, the show commenced 
when the child was only one year old ; and at ten 
years of age she was delivered of a full grown child. 
Menstruation is sometimes tardy in its appearance , 
not commencing until the twenty-third or twenty- 
fourth year. The character of true menstrual blood 
differs somewhat from blood taken from a vein in 
the arm ; and one of its peculiarities consists in its 
not coagulating, or forming clots ; exceptions to this 
rule are generally cases of abnormal menstruation. 
The reason assigned for this peculiarity of menstrual 
blood is, that the mucous membrane of the vagina 
secrets an acid fluid or mucous ; that as the blood in 
healthy menstruation passes out of the mouth of the 



22 THIRTY YEARS OF FEMALE LIFE. 

womb and enters the vagina ; it is mixed with the 
acid mucous, and thereby prevented from forming a 
clot. The effect of the vaginal mucous on the men- 
strual blood also acts as an antiseptic^ in preventing 
it from assuming a very offensive odor, which it, 
would acquire while it remained in the vagina 
were it not for this peculiarity of the vaginal secre- 
tions. " If the power which presides over the elab- 
oration of this antiseptic principle were for a time 
suspended, and the purposes which it serves re- 
main unsupplied, the secretions'' menstruation 
" would be constantly liable to thicken, accumulate, 
and putrify, giving origin to disturbances of the 
most unmanageable character.''* 

The menstrual discharge does sometimes assume 
an offensive odor, but this fact does not militate 
against the theory just advanced, as the peculiar 
action of the vaginal mucous may be counteracted 
by the menstrual discharge being in too great abun- 
dance, or the lining membaane of the vagina may 
not secrete the usual amount of this peculiar fluid 
from some abnormal condition ; there may be other 
causes, also, to counteract its influence. The length 
of time usually occupied at each menstrual period 
is from three to six days ; four or five days may be 
taken as the rule. It is liable, however, to consid- 
erable variation, not only amongst different females, 
but with the same woman at different periods. It 
also varies very much in quantity according to the 
temperament and state of health of the individual. 

*Whitehcad on Abortion and Sterility, paga 153 



THIRTY YEARS OF FEMALE LIFE. 23 

" As a general rule, persons of the bilious or lym- 
phatic bilious temperament have tlie menstrua in 
greatest abundance and continued for the longest 
period ; those of the sanguine temperament the con, 
trary. This may be owing, in some measure, to 
the free cutaneous transpiration generally observed 
in the last named class of persons. In lymphatic 
subjects, the discharge is usually abundant, but 
varies considerably, and is doubtless influenced ma- 
terially, by the amount of leucorrhoeal discharge 
voided in the intervals, to which affection this tem- 
perament predisposes more perhaps than any other."* 
Menstruation usually occurs every twenty-eight 
days, or lunar month, and from this circumstance it 
was formerly supposed that this function was influ- 
enced by the moon, but that theory has long since 
been refuted ; for we find females menstruating 
every day in the month. Twenty-eight days is the 
general rule, yet the periods may be farther apart, 
or occur every two or three weeks, without any ap- 
parent injury to the constitution ; in many cases the 
quantity lost being of more importance than the fre- 
quency of its appearance, as some would lose a 
larger quantity who menstruated ouly once in four or 
five weeks, than others who were regular twice a 
month. The quantity usually lost at each menstrual 
period is about six ounces, in some cases it is consi- 
derably more than this, in other cases much less. It 
is the opinion of most writers on the subject, that not 
only the time of its first appearance, but also the 

♦Whitehead, page 39. 



24 THIRTY YEARS OF FEMALE LIFE. 

quantity lost is influenced by climate ; the probabil- 
ity is, however, that the habits of life and peculi- 
arities of constitution have as much influence in this 
matter, if not more, than climate. 



CHAPTER IV. 

OBSTRUCTED MENSTRUATION. 

This complaint manifests itself under a variety of 
forms, which maybe divided into tw^o classes ; first, 
where the female, having attained a suitable age, has 
never menstruated. Second, where the courses, 
having been regular for a longer or shorter period, 
are suppressed before the time for the final cessa- 
tion of this function, and unconnected with pregnan- 
cy or nursing. 

In regard to the cases included in the first class, 
menstruation may be prevented from making its ap- 
pearance from a want of development, or absence 
of the ovaries, or womb, closure of the passage 
through the neck of the womb, adhesion of the va- 
ginal w^alls, closure of this passage by an imper- 
forate hymen, and from tardy puberty. If the ova- 
ries and womb are both absent, menstruation cannot 
take place. Where the womb is absent, and the ova- 
ries exist in full development, the menstrual flow 
may take place from the stomach, rectum, or other 
parts of the system. If only one ovary exists, men- 
struation may occur as though both organs existed. 



xHIRTY YEARS OF FEMALE LIFE. 25 

The ovaries being the principal organs concerned in 
the phenomena of menstruation, if they have never 
existed, or if destroyed by disease, or removed by 
an operation previous to the age of puberty, the ef- 
fect upon the female form is usually very marked. 
The person assumes a more masculine form, the 
breasts are not developed, the voice is harsh and 
masculine, hair often grows upon the chin, and the 
body does not develope into the symmetrical form of 
womanhood. The menstrual secretion may occur 
regularly every month, yet not make its appearance 
externally, in consequence of the vagina or passage 
through the neck of the womb being closed by ad- 
hesion, false membrane, or imperforate hymen. 
Under such circumstances, the courses gradually ac- 
cumulate in the womb, until it becomes greatly dis- 
tended. The general health becomes greatly affect- 
ed, the patient complains of pain in the back and 
loins, which, at first, is increased at each monthly pe- 
riod, but afterwards becomes more constant ; the 
appetite fails, the bowels are constipated, the abdo- 
men tender, and the patient becomes pale, thin and 
exhausted, and if not relieved by art, a rupture of 
the womb, followed by fatal results, may occur. If 
the mouth of the womb is closed by a membrane, or 
the passage through the neck of the womb is closed 
by adhesion, an artificial opening may be made with 
the trocar, which should be prevented from closing 
again, by introducing, from time to time, a bougie of 
suitable size, until a permanent opening is obtained. 
As soon as the womb is opened, the retained courses 



26 THIRTY YEARS OF FEMALE LIFE. 

escape, and as the most fluid portion is generally ab- 
sorbed before the operation, that which escapes is 
quite thick and of a very dark color. Puncturing 
the womb through the rectum has been resorted to, 
where it could not be reached by the vagina. When 
there is adhesion of the vaginal walls, a passage has 
been made by gradually tearing the parts asunder ; 
an artificial vagina has also been formed with the 
knife, the new passage being prevented from again . 
adhering, by introducing a piece of sponge or roll of 
soft linen, until the parts have healed. If the hy- 
men is so dense that it cannot be ruptured with the 
end of the finger, a knife is used. After making 
these artificial openings, the parts are to be syringed 
out occasionally with warm water, or mucilaginous 
injections. If inflammation supervene,general bleed- 
ing may be required ; also opium, leeches to the 
parts, cold lotions or hot fomentations. The bowels 
should be freely evacuated and kept open by saline 
apperients. The after treatment consists in restor- 
ing the general health, by some preparation of iron, 
quinine, and other tonics ; a generous diet and ex- 
ercise in the open air. The menstrual fluid accumu- 
lating in the womb has, in some cases, caused morn- 
ing sickness, enlargement of the breasts, with secre- 
tion of milk, and other symptoms of pregnancy ; 
and persons laboring under obstructed menstruation 
have not unfrequently been charged with being 
pregnant. In other cases,the courses are absorbed 
during the intermission between the periods, without 
producing any serious inconvenience. 



THIRTY YEARS OF FEMALE LIFE. 27 

" The mere circumstance, indeed, of a girl having 
passed the age at which menstruation usually ap- 
pears, without performing that function, is not of it- 
self a reason for medical interference. The date of 
puberty varies very widely, and one woman may 
menstruate at ten, and another at twenty years of 
age, without the health of either being of necessity 
impaired. Usually, the absence of menstruation in 
otherwise healthy young women, is associated with 
the absence of some of the other signs of puberty, 
indicating a generally tardy sexual development, 
just as, without apparent cause, one tree will produce 
blossoms, and bear fruit later than another. This, 
however, is not always the case, and instances are 
sometimes met with of persons in whom pregnancy 
has preceded menstruation, completeness of sexual 
powder having existed, though not manifesting itself 
by its ordinary sign."^ 

Cases of obstructed menstruation from malforma- 
tion of the organs, or mechanical obstruction, are 
only occasionally met with, but the non-appearance 
of the courses at the usual time, from tardy puberty, 
associated with a debilitated condition of the sys- 
tem, is of common occurrence; the girl arrives at the 
age of puberty physically unprepared for the change, 
which is apparent from her bloodless countenance 
and other indications of ill health, recognized by the 
term chlorosis, which is frequently attended with 
serious constitutional disturbance, and requires a 

* West on Diseases of Women, page 36. 



28 THIRTY YEARS OP FEMALE LIFE. 

thorough course of toinc and invigorating treatment. 
Cases occasionally occur, where the menstrual flow 
fails to make its appearance, from an opposite condi- 
tion of the system, that of plethora, characterised by- 
symptoms of a congestive form, as pain in the head 
and throbbing of the temples, flushed face, pulse full 
and strong, pain in the back and lower part of the ab- 
domen, extending to the groins and thighs, with 
weight and fullness of the pelvis. The patient may 
experience symptoms of this description at stated 
periods of four or five weeks, which are relieved by 
menstruation becoming established. At other times, 
this habit, acquired at puberty, may continue through 
life, each menstrual period being attended with in- 
tense sufl'ering ; or, these violent efforts not being 
relieved by proper treatment, and the courses not 
appearing, the general health is finally destroyed, and 
the condition of debility previously mentioned, 
induced. 

Treatment. — The bowels should be freely evacu- 
ated by some active cathartic, as the aloetic pill, and 
kept in a soluble condition by saline apperients; cold 
applications to the head, and in some cases, leeches 
may be applied to the temples or nape of the neck ; 
soaking the feet in hot Avater has a tendency to relieve 
the head by equalizing the circulation, and in this way 
encourage the flow; also,sitting over the steam from 
hot herbs, or sitting in hot water, or a mustard plas- 
ter, or fomentations to the bowels ; cupping or 
leeches to the lower part of the back, and inside of 
the thighs. Emetics do good in some cases ; also 



THIRTY YEARS OF FEMALE LIFE. 29 

camphor, three grains, extract of hyoscyamus, three 
grains, in pill, one for a dose,four or six hours apart ; 
spirits of mindererus one ounce, spirits of nitre half 
an ounce ; dose, one or two tea-spoonsful in a wine 
glass of water, three or four hours apart ; in some 
instances, bleeding from the arm may be required. 
The pain in the back will often be relieved by an 
injection up the rectum, of a tea-spoonful of laudan- 
um in half a cupful of warm water or thin starch. 

During the intermission between the periods, the 
bowels should be kept free by saline apperients, 
as Epsom salts and others of this class ; also, a tea- 
spoonful of the volatile tincture of guiac, in a wine 
glassful of sweetened milk and water, three times a 
day, will be of service in some cases. Forcing med- 
icines, such as tansy, savin and the like, will be 
rarely indicated. Electricity has been followed 
w4th good results in some cases. 

During infancy, the womb and ovaries having no 
important functions to perform, are small and unde- 
veloped. This condition may remain through life ; 
when this is the case, menstruation cannot take 
place ; and should the female, under such circum- 
stances, contract marriage, she will be sterile. 

In other cases, menstruation occurs three-or four 
years later than common, the reproductive organs 
having attained that development, together with 
strength of constitution, necessary to the perfor- 
mance of this function. Some diseases, particularly 
scarlet fever, coming on about the age of puberty ,re- 
tard menstruation several years. In regard to cases 



30 THIRTY YEARS OF FEMALE LIFE. 

included in the second class, menstruation having 
been established for a longer or shorter period may be 
obstructed from exposure to cold, from grief, fear, and 
other impressions of the mind ; from sexual inter- 
course during menstruation, from misplacement of 
the womb; from profuse leucorrhoea and uterine he- 
morrhage, by reducing the healthy condition of the 
blood, causing a debilitated condition, as observed in 
chlorosis ; from fever, and other diseases occurring 
about the regular monthly period. Consumptive 
patients are also frequently subject to obstructed 
menstruation, and in some rare instances, the vagina 
has been closed, from the effect of inflammation, after 
delivery. Closure of the mouth of the womb has 
also occurred from the same cause. The symptoms 
vary considerably, according to the cause and con- 
dition of the patient ; and whether the suppression 
is acute or chronic. In some cases, the female ex- 
periences littl'e inconvenience, but generally, sooner 
or later, considerable derangement of the system oc- 
curs, and in other cases, the most serious results fol- 
low. When the courses are suddenly checked, 
from cold, or any other cause, there is sometimes 
great disturbance of the system, attended with 
pain in the head, throbbing of the temples, flushed 
face, thirst, sickness of the stomach, hot skin, quick 
pulse, pain in the back and limbs, pain in the lower 
part of the abdomen, extending to the groins and 
thighs, weight and fullness in the pelvis ; and in some 
cases, the patient is attacked with fainting, hysteric 
or epileptic convulsions, inflammation of the brain, 
lungs, bowels, bladder^ ovaries or womb. 



THIRTY YEARS OF FEMALE LIFE. SI 

Treatment. — In some cases, unattended with any- 
very prominent symptoms, soaking the feet in hot 
water, a gentle cathartic, and a cup of hot herb tea 
will be sufficient. In other cases, attended with se- 
vere constitutional disturbance, an active course of 
treatment will be required. The menstrual flow 
should be encouraged by soaking the feet in hot 
water, a hot sitz bath, or sitting over the steam from 
hot herbs, by hot drinks, a mustard plaster to the 
bowels, or hot fomentations, by mustard plasters to 
the calves of the legs, or inside of the thighs : leeches 
applied to the inside of the thighs, are of service in 
some cases. The bowels should be moved by cas- 
tor oil or some other cathartic medicine, and after- 
wards kept freely open by salts and senna, cream of 
tartar, half an ounce, epsom salts, one ounce, water, 
half a pint. 

Dose — a wine glass full, night and morning, or 
only once a day, according to effect. 

The pain in the lower part of the abdomen and 
back, which is often very severe, will be relieved by 
thirty or forty drops of laudanum, and a mustard 
plaster to the abdomen : or a tea-spoonful of lau- 
danum in half a tea-cupful of w^arm water, or thin 
starch injected up the rectum. Camphor is also of 
service, combined with some narcotic, as opium, or 
extract of hyoscyamus three grains, pov\"dered gum 
camphor, three grains, in pill, three or four hours 
apart ; fifteen or twenty drops of spirits of camphor 
in a little sweetened water. A mustard plaster, ap- 
plied over the stomach, will often relieve the nausea 



32 THIRTY YEARS OF FEMALE LIFE. 

and sickness. Two or three grains of powdered ipe- 
cac will sometimes quiet the stomach, or some mint 
tea. If the sickness continues, an emetic may be 
given, spirits of minderera one ounce, and spirits of 
nitre half an ounce. 

Dose. A tea-spoonful every three or four hours 
will be of service. 

If the patient is feverish, also, nitrate of potassa, 
one drachm, Avater three table-spoonsful. 

Dose. A tea-spoonful, four or six hours apart. 
Dover powder, five grains, powdered camphor, two 
grains, four or six hours apart. Two grains of calo- 
mel, with the Dover powder and camphor ; or half a 
grain of podophyllin, will have a good eifect in many 
cases ; also, gelsemin, one quarter or half a grain, 
every three or four hours. 

If there is pain in the head, apply hot applica- 
tions to the feet, and cold to the head. If the face 
is flushed, with throbbing of the temples, apply a 
blister to the nape of the neck, or leeches to the 
temples ; in some cases, bleeding from the arm is in- 
dicated. 

The menstrual flow coming on, generally brings 
relief to the patient, and renders further interfer- 
ence unnecessary ; there are exceptions, how^ever, 
to this rule. The attack may pass over without a 
return of the courses, or the discharge, instead of 
being of the natural color, is sometimes a more or 
less profuse leucorrhoea ; yet when this is the case, 
relief is frequently obtained. 

It is not an uncommon occurrence for young fe- 



THIRTY YEARS OF FEMALE LIFE. 33 

males, just beginning to menstruate, to have the 
courses suppressed for two or three months, or even 
longer, after the first show ; and in the mean time, 
there is frequently a white discharge at the regular 
period, in place of the red, or the discharge for the 
first four or five periods is sometimes white ; and 
some women, Avho are regular in their menstruation, 
observe a white discharge one or two days before 
the natural courses appear. 

Chronic suppression of the courses. — This form 
of suppression is frequently met with, and may oc- 
cur at any period of menstrual life, and continue 
several months, and in some cases for years. It may 
result from an acute attack, and other causes previ- 
ously mentioned, but a debilitated condition of the 
system is more frequently the cause. 

Symptoms. — As a general rule, a female will men- 
struate, if the system is in a condition to bear the 
loss of menstrual blood from the circulating fluid, 
and the organs concerned in this function are in a 
condition to perform their office. Suppressed mens- 
truation, therefore, is of itself a symptom that one 
or both of these conditions do not exist. Without 
controverting this position, it may be stated in this 
connection, that all women are not well, although 
regular in their menstruation ; that some women 
who menstruate only once or twice a year, and in 
some rare instances, not at all, enjoy a fair degree of 
health ; also, that a female may continue to menstru- 
ate when the system is in a weak, debilitated condi- 
tion. Frequently, however, in cases of impaired 



34 THIRTY YEARS OF FEMALE LIFE. 

health, nature, ever watchful over all her works, and 
guarding every function with a jealous care, inter- 
rupts the menstrual function, when the organism 
would be still further impaired, should this periodic 
loss of blood continue. The symptoms, then, of ob- 
structed menstruation, will be modified by the 
cause of the suppression, and the general health of 
the patient. 

In many cases, the patient complains of pain in 
the back and lower part of the abdomen, extending 
to the groins and thighs, a sensation of weight in 
the pelvis, and bearing down, pain in the head, 
chills and flashes of heat, with other symptoms of 
fever, which, at first, recur regularly about such 
a time every month, and, judging from her feelings, 
the patient expects to be unwell, yet in a day or 
two, this eff'ort of nature passes over without pro- 
ducing the show, and she feels quite well again. 
Sooner or later, the health begins to decline, the 
appetite and digestive function becomes aff'ected, 
and the bowels irregular in their action ; she is 
troubled with costiveness, and the inconvenience 
arising therefrom ; or this condition may alternate 
with diarrhoea. 

The pains which, at first, occurred at stated pe- 
riods, may become constant, or occur at any time ; 
the least exertion causes fatigue ; palpitation of the 
heart, and pain under the left breast are often ex- 
perienced, particularly if the patient is subject to 
leucorrhoea, which is often the case : this debilitat- 
ing discharge, producing its train of symptoms, 



THIRTY YEARS OF FEMALE LIFE. 35 

and reducing still further the vital powers. There 
.is frequently nausea and vomiting, loathing of food, 
and strange longings for unnatural articles of diet ; 
in some cases there is a ravenous appetite ; the face 
is pale and bloodless, the breath foetid, the tongue 
coated, and a dark circle under the eyes ; the feet 
and legs swell, the sleep is disturbed by unpleasant 
dreams, and she awakes in the morning languid and 
unrefreshed ; or the patient is drowsy, and disposed 
to sleep more than common ; she becomes thin and 
emaciated, and in some instances, considerably bloat- 
ed, particularly about the face. Difficulty of breath- 
ing, tightness and soreness across the chest, and 
cough are symptoms frequently experienced in this 
complaint : the cough does not always denote or- 
ganic disease of the lungs ; yet, suppressed men- 
struation sometimes terminates in consumption. 
Hysteria and other nervous affections are frequently 
met with in suppressed menstruation, and in some 
instances, spinal affections, derangement of the 
functions of the brain and insanity. 

Treatment. — There is no complaint to which fe- 
males are liable, of more common occurrence, than 
suppressed menstruation ; and in none is the proper 
course to be pursued, more plainly indicated bj^ 
the symptoms ; yet great difficulty is often experi- 
enced in restoring the menstrual secretion. 

There are two principal causes for this unsatisfac- 
tory result. In the j€r5^ place — among that class of 
remedies called emmenagogues, which means, medi- 
cines possessing certain properties capable of pro- 



36 THIRTY YEARS OF FEMALE LIFE. 

ducing menstruation, there is no known remedy pos- 
sessing this power in all cases, even when the sys- 
tem is in a favorable condition for their adminis- 
tration. 

Second. — The suppression is too frequently treat- 
ed as a local difficulty only ; and here lies the se- 
cret of success or failure in many cases. Dr. Wm. 
Hunter very aptly remarks — "Now, my opinion 
with regard to the management of the menses is, 
that you pay no regard to them, but endeavor to 
put her to rights in other respects. If you cure 
the other disorders, you cure the irregularity of the 
menses, which is the consequence and not the cause 
of her complaints.'' 

The correctness of the opinion in regard to this 
subject, entertained by the author just quoted, is 
verified by experience. We should look beyond 
the mere local affection, to the abnormal condition 
of the reproductive organs, and the general health 
of the patient. If she is weak and debilitated, tonics 
are indicated, such as quinine, twenty grains, sul- 
phate of iron, twenty grains, made into twenty pills 
with extract of dandelion, one pill morning, noon, 
and night ; compound tincture of Peruvian bark 
and compound tincture of gentian, of each one 
ounce. Dose^ one or two teaspoonsful, in a wine 
glass of water, three times a day ; salicin two grains, 
three times a day. Elixir of vitrei or muriated 
tincture of iron, ten or twelve drops, in a wine glass 
of water, three times a day. Sulphate of iron, 
twenty grains, myrrhae twenty grains, carbonate of 



THIRTY YEARS OF FEMALE LIFE. 37 

potassa, fifteen grains, make twenty pills, one, two 
or three times a day; lactate of iron, in pill or syrup. 
Dose, one grain, gradually increased to three, or 
four grains, three times a day ; Vallet's preparation 
of iron, in pill. Dose, three or four grains, three 
times a day. 

Some patients will take one preparation of iron 
with benefit, that cannot take some other prepara- 
tion of the same drug ; also in regard to the muriat- 
ed tincture of iron, the dose at first should be small, 
ten or twelve drops, gradually increased to twenty 
or thirty. 

Vegetable tonics, besides those already mention- 
ed, will be of service in some cases, such as chamo- 
mile flowers, wild cherry bark, columbo and others, 
also wine, and a generous diet ; exercise in the open 
air forms an important part of the treatment, not 
only in this, but many other complaints of females ; 
but the amount of exercise should be regulated by 
the powers of the system to endure it. 

The liver is frequently in a torpid condition, and 
the bowels constipated, and in cases where diar- 
rhoea alternates with constipation, the liver is often 
at fault. To correct this abnormal condition, is of 
the first importance. The bowels should be moved 
by a dose of castor oil, or some other cathartic, as 
the following : calomel, ten or twelve grains, jalap, 
fifteen grains, ipecac, four to six grains, mixed in 
syrup or stewed fruit, and taken at a dose ; or podo- 
phyllin, two or three grains, leptandrin. four to six 
grains. 



38 THIHTT YEARS OF FEMALE LIFE. 

To act on the liver, give two or three grains of 
calomel, or mercury, with chalk, five to ten-grains, 
blue mass, three to six grains, podophyllin, one 
quarter to one half grain, with two grains of leptan- 
drin, once, twice, or three times a day, according 
to the effect on the bowels, a gentle daily movement 
being all that is required. Elixir proprietatis is 
given, with good effect, in some cases ; it imparts 
tone to the stomatjh, and is a good laxative, in doses 
of a teaspoonful two or three times a day ; also, 
sulphate of iron, twenty grains, aloes, forty grains 
made into twenty pills, one, two or three times a 
day, a teaspoonful of the fluid extract of dandelion, 
twice or three times a day ; or a decoction of the 
root will be of service in cases where the liver is 
torpid and the bowels irregular. As an alterative 
and tonic, the following preparation will be found 
very beneficial in many cases. Hydriodate of po- 
tassa, thirty grains, compound tincture oi gentian, 
two ounces, compound syrup of sarsaparilla, two 
ounces, extract of dandelion, half an ounce. Dose^ 
one or two tea-spoonsful, two or three times a day ; 
or a syrup of burdock, yellow dock, and dandelion 
roots, with wild cherry bark. 

Should the suppression continue, after the general 
health has been improved, or in cases of suppres- 
sion, unattended with constitutional disturbance, or 
serious disturbance of the health, remedies tending 
in their action to assist the menstrual flow, may be 
given, such as the volatile tincture of guiacum. 
Dose, a tea-spoonful, three or four times a day, in a 



THIRTY YEARS OF FEMALE LIFE. 39 

little sweetened water or milk. Hooper's pills have 
come into pretty general use among females, in 
cases of suppression ; they are made as follows : — 
Barbadoes aloes, one ounce, sulphate of iron, half 
an ounce, extract of black helebore, two drachms, 
myrrhge, two drachms, Castile soap, two drachms, 
powdered canella alba, one drachm, ginger, one 
drachm. After mixing the several ingredients well 
together, they are to be beat into a mass by adding 
a little water ; then made into common sized pills, 
three or four of which generally act pretty freely 
as a cathartic. 

To keep up a regular action of the bowels, and at 
the same time produce a tonic effect, one or two 
pills may be given, once, twice or three times a day. 

Madder has long been used in cases of suppression, 
with favorable results, in some instances ; as it is 
less likely to cause inflammation of the womb, or 
ovaries, than savin, and it may be added, less likely 
to induce menstruation, there is no particular ob- 
jection against its use. Dose^ half a drachm to a 
drachm and a half of the powdered root ; or one 
ounce of the powdered root may be steeped in a 
pint of hot water. Dose^ a wine-glass full, three or 
four times a day. 

The bark of the root of the cotton plant is held 
in high repute in the southern states, as a remedy 
in suppressed menstruation. Dose^ of the fluid ex- 
tract, one or two table-spoonsful, four or six hours 
apart ; Iodine, fifteen grains, hydriodate of potassa, 
thirty grains, alcohol, one ounce. Dose, ten to 



40 THIBTY YEARS OF FEMALE LIFE. 

twenty drops in a wine glass of water or wine three 
times a day. This forms a valuable remedy in many 
cases of suppressed menstruation, particularly in 
debilitated conditions of the system, and in patients 
of a scrofulous habit. Strychnia has been favor- 
ably mentioned by Drs. Churchill and Bardsley, in 
suppression of the courses, and although a most 
virulent poison, it is a valuable remedy in some other 
complaints, in minute doses ; and being a powerful 
tonic and excitant, may be of service in suppressed 
menstruation, by imparting strength and tone to the 
organism. If there is acidity of the stomach, the 
activity of the drug is greatly increased, so that a 
moderate dose, perfectly safe under other circum- 
stances, may not only produce alarming symptoms, 
but even prove fatal. Dose, one twentieth or one 
fifteenth of a grain, gradually increased to one 
tenth or to one fourth of a grain, twice or three 
times a day ; it is best administered in pill form, on 
account of its intense bitter taste. Its effects 
should be closely watched, and the medicine imme- 
diately discontinued, if the patient complains of 
heat in the stomach, nausea and vomiting, a sensa- 
tion as if falling, heat and pricking, or creeping 
sensations of the limbs, or twitching of the muscles. 
Cantharides have been given with favorable results, 
it is stated by good authority, in some cases of sup- 
pressed menstruation. It is generally administered 
in the form of tincture. Dose, ten to twenty or 
thirty drops, twice or three times a day, in a wine 
glass of water, flax-seed tea, or some other bland 
fluid. 



THIRTY YEARS OF FEMALE LIFE. 41 

In some cases, the medicine affects the bladder, 
producing great difBculty in passing water ; when 
this is the case, relief will be obtained by injecting 
up the rectum a tea-spoonful of laudanum, in 
about half a pint of warm water, also by applying 
to the external parts, warm water, or sitting over 
the steam from hot herbs. Ergot has long held a 
favorable position in the treatment of suppression 
of the courses, but, judging from its effects in exci- 
ting contractions of the womb at delivery, and from 
the fact that it is a good remedy to check the mens- 
trual discharge, when too profuse, it is difficult to 
understand how it can be of service in suppression, 
yet it is recommended by Dr. Dewees, and other 
eminent practitioners ; but Dr. Churchill says, " I 
tried it, in consequence of the high authority of 
these writers, but it failed, as in truth, I expected 
it would." Dose^ the tincture, twenty to thirty 
drops, in a little sweetened water, three or four 
times a day ; or a drachm of the powdered ergot, 
steeped in half a pint of water. Dose^ one or two 
table-spoonsful, three or four times a day. It may 
also be given mixed with cold water, by steeping 
the powder in milk ; it is less likely to cause nausea. 
It should not be continued long, and be discontinued 
if it produces pain in the womb. Rue, tansy, and 
savin have been found useful in some cases, but 
these and other forcing medicines, are rarely re- 
quired, if a proper course of treatment has been 
pursued, and the system restored to a healthy con- 
dition ; and if this has not been attained, it would 



42 THIRTY YEARS OF FEMALE LIFE. 

be injudicious to recommend them ; for, if not posi- 
tively injurious, they would do no good, if the sys- 
tem and organs concerned in menstruation, were 
not in a fit condition for this function to take place. 
Even a bowl of hot penny-royal tea, a hot sitz 
bath, or sitting over the steam from hot herbs, or 
any other means, to encourage menstruation, should 
not be resorted to if the patient is weak and debili- 
tated ; but after this condition has given way, by 
proper treatment, to improved health, and should 
the courses not make their appearance from a tor- 
pid, inactive state of the reproductive organs, the 
menstrual function may be encouraged by soaking 
the feet and legs in hot water, a hot sitz or hip 
bath, and other means previously mentioned, with a 
probability of success, and benefit to the patient. 

It is in such cases that electricity, or applications 
of the galvanic battery will be of service ; but, like 
other remedies, it not unfrequeritly fails in restoring 
the menstrual secretion. That it would be success- 
ful , more frequently, there is no doubt, were it ap- 
plied only in such cases where the system is in a 
suitable condition for menstruation to take place ; 
and were the applications made at a proper time, and 
in a right way ; for it must be apparent to every 
one, that in the use of any remedy capable of induc- 
ing, under certain circumstances, an important func- 
tioiLlike menstruation, there must be a wrong as well 
as right way of using it. We should not be 
surprised, then if electricity fails, Avhen improperly 
applied. The kind of electricity employed for med- 



THIRTY YEARS OF FEMALE LIFE. 43 

ical purposes, has much to do with the success or 
feilure of this agent. 

That form of electricity generated by the galvan- 
ic battery, is the best adapted to cases of suppress- 
ed menstruation, and of this form, the direct current 
should be used. The to and fro current has no 
specific action in these cases. In regard to the mode 
of application, in this complaint, the negative pole 
of the direct current should be applied to the lower 
part of the spine, and the positive pole moved 
about over the lower part of the bowels, over the 
ovarian region ; or, the positive pole may be intro- 
duced up the vagina, to the mouth of the womb, 
and the negative pole applied up and down the 
spine, and over the abdomen. Ten or fifteen minutes 
is usually long enough to continue the application. 
This maybe repeated every day, or every other day, 
according to circumstances. The strength of the 
currei;it must be regulated by the sensation produ- 
ced. Some patients can bear it much stronger than 
others, and in no case is it necessary to apply it so 
strong as to produce painful contractions of the 
abdominal muscles. 



4A THIRTY YEARS OF FEMALE LIFE. 



CHAPTER V. 

CHLOROSIS, OR GREEN SICKNESS. 

This complaint usually makes its appearance 
about the age of puberty, and is characterised by 
aggravated symptoms of general ill health. It is 
not, however, confined to the period of first menstru- 
ation, as it sometimes occurs at the last menstrual 
crisis, and at other periods of life. That it is 
intimately connected with the menstrual function, 
there seems to be little doubt, as it not unfrequently 
results from suppressed menstruation ; but more 
frequently, a chlorotic condition of the system is 
the cause of the non-appearance, or suppression of 
the courses. The color of the skin, which is fre- 
quently of a peculiar yellowish or greenish tinge, has 
given rise to the term chlorosis, or green sickness. 
Girls that have grown up rapidly, and, as it were, 
outgrown their strength, or those naturally of a 
frail, weakly constitution, and previously sickly, are 
often subject to this complaint. If they attain to 
the age of puberty, they are physically unprepared 
for the change, which is evident from the undevel- 
oped form, pale, bloodless countenance, and other 
indications of an impoverished condition of the 
blood. 



THIRTY YEARS OP FEMALE LIFE. 45 

The courses may not come on, but in place of the 
red, there is often a white discharge, which de- 
creases the already exhausted vital forces, or she 
may have been subject to the whites for a long 
time previous. The health declines more and more, 
and at last, the frail child, unable to pass the first 
critical period of female life, withers and dies on 
the very threshold of womanhood. In some cases, 
attended with a feeble condition of the system, 
menstruation occurs, but the discharge is of an un- 
healthy appearance, pale and watery. Sooner or 
later, however, it ceases altogether, or it is super- 
seded by the whites, and increases the general de- 
bility, which gradually assumes the chlorotic form, 
until all doubts in regard to the malady are re- 
moved, and the patient rapidly declines in health. 
In other cases, the patient comes to puberty, enjoy- 
ing a fair degree of health, the usual development 
of form, and regular in her menstruation, but in con- 
sequence of taking cold, or from some cause, previ- 
ously mentioned under the head of suppressed men- 
struation, the courses are suppressed, and if not re- 
lieved by judicious treatment, sooner or later, symp- 
toms of chlorosis manifest themselves. 

Causes. — The condition of the system, recognised 
by the term chlorosis, is the result of deficient vital 
action : hence, any cause disturbing or interfering 
with the healthy performance of the different func- 
tions of the body, may conduce to this complaint. 
All the different organs and tissues, of which the 
human organism is composed, unite to form the 



46 THIRTY YEARS OF FEMALE LIFE. 

complete whole ; each has its special office to per- 
form, and all are kept in action by nerve power. 
The nerves are the medium of communication be- 
tween different organs, either direct, or by sympa- 
thetic action ; as an illustration, it is only necessary 
to refer to the symptoms observed in pregnancy, 
from the alteration in size and position of the womb. 
In many complaints, and particularly in most 
cases of chlorosis, the first point of departure from 
a healthy condition, is in the nervous system ; the 
derangements of the functions of the internal organs 
follow, as a necessary consequence. During life, 
there is a constant waste of tissue going on, which 
is as constantly replaced by new material, furnished 
by the blood. If this vital fluid is rendered impure 
and unhealthy, from impaired digestion and assimi- 
lation, an unhealthy condition of the system is the 
result ; just what is observed in chlorosis. The 
causes, capable of disturbing the vital processes, 
are numerous. In some cases, the girl inherits a 
feeble constitution, which is manifested in early life ; 
she is a weakly child ; easily made sick from the 
slightest cause, and more predisposed to the com- 
plaints incident to childhood, than those of a 
more robust constitution. As she grows up, she 
looks pale and thin ; and in many cases she is sub- 
ject to leucorrhea. Measles, scarlet fever, and other 
diseases of childhood, sometimes induce a like con- 
dition of the system, in girls previously healthy. 
In either case, as the period of puberty approaches, 
they are frequently subjects of chlorosis. 



' THIRTY YEARS OF FEMALE LIFE. 47 

The opinion is often entertained, in regard to 
young girls of a weakly constitution, that they will 
outgrow it, and all will be right when they arrive at 
the age of womanhood. That such a favorable 
result occasionally occurs, there is no doubt, but 
the reverse is more frequently the case. If the 
girl is weak and feeble, the probability is, if ker 
health is not restored before the age of puberty, 
she will be chlorotic, or suffer in after life, from some 
form of female malady, so common at the present 
day. It is often the case, that young girls are too 
much confined in overheated and badly ventilated 
school-rooms, overtaxed with studies, occupying so 
much of their time, that they do not have that 
amount of out-door exercise necessary to the devel- 
opment of a healthy constitution ; they are made 
accomplished, according to the common acceptation 
of the term, at the expense of health, and very 
often, the mistake is not discovered until too late to 
remedy a defective course of education. Like hot- 
house plants, they may please the eye of those ig- 
norant of the consequences of over stimulating the 
brain and nervous system, without a due regard to 
the physical development, by invigorating out-door 
exercise ; but they soon fade, unable to endure the 
trying scenes of life. In some places, particularly 
large towns and cities, large numbers of young 
girls are put to some occupation, as soon as they 
can obtain a situation ; frequently in shops and 
factories, where they are confined from morn till 
night, taxed with work beyond their years, and 



48 THIRTY YEARS OP FEMALE LIFE. 

subject to privations of various kinds. Should we be 
surprised, then, if they fail in health, and become 
chlorotic, when they arrive at puberty ? or, if the 
first critical period is passed, that they should be 
afflicted, in after life, with ills peculiar to the sex? 
As previously stated, there is a constant waste of 
tissue going on, which is replaced by new material, 
furnished by the blood ; this process is called as- 
similation. In chlorosis, the blood is impoverished ; 
the proportion of water increased, and the other 
constituents from which new tissue is formed, de- 
creased. As a consequence, the process of assimi- 
lation is but imperfectly performed. The blood is 
formed from the food, after it has undergone the di- 
gestive process. Digestion and assimilation depend 
upon nervous energy ; if, therefore, there is defi- 
cient nervous power, the blood becomes unfit to be 
assimilated into new tissue, and keep up a healthy 
condition of the body. Want of exercise, a seden- 
tary habit, unwholesome food, living in an unhealthy 
situation, mental affections, or any cause, producing 
derangement of the digestive function, either di- 
rectly, by afi'ecting the stomach and bowels, or indi- 
rectly, by weakening the nervous energy, may cause 
chlorosis. Obstructed menstruation sometimes 
causes this complaint, but more frequently, a feeble 
condition of the system, either inherited or acquired, 
is the cause of the obstruction. Leucorrhoea is, by 
some, regarded as a cause of chlorosis, but as leu- 
corrhoea is a symptom of local inflammation, or 
local or general weakness, it follows, that the condi- 



THIRTY YEARS OF FEMALE LIFE. 49 

tion of the system causing the white discharge, is 
really the cause of chlorosis. Too long continued 
nursing, profuse menstruation, or uterine hem- 
orrhage, occurring after an abortion, or at any other 
time, may cause chlorosis, by weakening the system, 
deranging the digestive process, and reducing the 
hearthy condition of the blood. 

Symptoms. — The patient is pale and languid, easi- 
ly fatigued, the feet and hands cold, the appetite 
variable : and in some cases, there is nausea and 
vomiting ; sometimes she complains of pain in the 
head, aching of the bones, pain in the region of the 
liver, and in the breast, extending through to the 
shoulder, pain in the back and lower part of the ab- 
domen, extending to the groins and thighs ; the 
liver is frequently in a torpid, inactive condition, 
and the bowels constipated ; the urine is sometimes 
turbid, and deposits a sediment on standing. In 
consequence of deficient vital action, digestion and 
assimilation are imperfectly performed ; the blood 
becomes impoverished, the flesh wastes, the feet and 
legs swell, a dark circle is observed under the eyes, 
the face is frequently bloated, the eyelids puffy, par- 
ticularly in the morning, the sleep is disturbed by 
unpleasant dreams, and there is a bad taste in the 
mouth, with foul breath ; diarrhoea, in some cases, 
alternate3 with constipation ; the skin frequently 
assumes a peculiar yellowish or greenish tinge ; 
the courses are generally suppressed ; occasionally, 
menstruation continues for a considerable time, at 
least, but the color of the show is usually pale and 



50 THIRTY YEARS OF FEMALE LIFE. 

watery ; leucorrhoea is often present and increases 
the general prostration. The same effect is ob- 
served, if menstruation continues. She is frequent- 
ly subject to palpitation of the heart, particularly 
on the least exertion, as ascending a flight of stairs ; 
in some cases there are strange longings for impro- 
per articles of diet, as chalk, clay, slate pencils, coal, 
and others quite as crude and unnatural. St. Yitus' 
dance, epilepsia, and hysteric paroxysms, are often 
met with in chlorotic patients. As the complaint 
progresses, the health declines more and more ; the 
flesh wastes, and night sweats occur ; in many 
cases, a troublesome cough sets in, which frequently 
terminates in consumption. 

Treatment. — The course of treatment recom- 
mended in cases of suppression of the courses, will 
be indicated in chlorosis. Although important to 
pay particular attention to the bowels, after they 
have been freely evacuated, very active purgation 
should be avoided, as it weakens the patient, in 
spite of tonic treatment. If constipation continues, 
gentle laxatives should be given, to keep up a regu- 
lar action of the bowels, but even these may be dis- 
pensed with, if the liver is acted upon by proper 
remedies. Cold salt water bathing, or sponging, 
will be very beneficial in many cases of chlorosis, 
and where the patient cannot visit the sea side, com- 
mon salt, added to fresh water, will answer the pur- 
pose very well. It is best to commence with the 
water a little warm at first, and gradually reduce 
the temperature, as the patient becomes accustomed 
to it. 



THIRTY YEARS OF FEMALE LIFE. 61 



CHAPTER VI. 

PAINFUL MENSTRUATION. 

When the diflferent parts of the human organism 
act in harmony, there is a healthy performance of 
the several functions ; a want of harmony, therefore, 
may be called a want of health, and in no case, is 
this inharmonious action more manifest, than in the 
generative organs of woman. Painful menstruation 
is a more or less painful attack, at each monthly pe- 
riod, existing in many cases, for a number of years, 
or for life, with an occasional mitigation of the suf- 
fering. It usually comes on one or two days, and 
in some cases, a few hours, before the show makes 
its appearance, and may be very severe, resembling 
labor pains. As soon as the flow is fully established, 
the pain generally subsides. The patient complains 
of pain in the region of the womb and ovaries, ex- 
tending to the groins and inside of the thighs ; in 
some cases, the pain in the back is very severe. 
Headache is, also, a troublesome and very common 
symptom, together with chills, flashes of heat, 
flushed face, hot skin, thirst, and a full, bounding 
pulse. In some cases, when the fever runs high^ 
delirium occurs, for a short time. In the menstrual 
discharge, there is sometimes observed a membrane^ 



52 THIRTY YEARS OF FEMALE LIFE. 

0U3 or skinny substance, in small patches or shreds; 
it resembles the false membrane from the throats of 
children affected with croup. Sometimes it has 
been found entire, like a small bag, and has given 
rise to the suspicion of pregnancy. " As the first 
cases in which this membrane was discharged, were 
those of women who were married, a doubt arose 
in my mind, whether it Avas really a consequence of 
early conception, but I have, of late, had the most 
undoubted proofs, that it is sometimes discharged 
by unmarried women, and may be formed previous 
to, and without connubial communication ; and that 
the uterus has occasionally, or constantly, in some 
women, the property of forming it, at, or in, the in- 
terval between the periods of the menstrual 
discharge.''^ 

This '' property" is an inflammatory condition of 
the interior of the womb, communicated, no doubt, 
in many cases, from, the ovaries, they being in a 
like condition, and if there ever was a doubt in re- 
gard to the capacity of the unimpregnated womb 
to form this membraneous substance, recent inves- 
tigations have settled the point : in fact, it is more 
than probable, that it occurs more frequently with 
the unmarried, than with those living in wedlock ; 
and even among the latter, pregnancy is not apt to 
take place, so long as this peculiarity exists, being 
considered as one of the causes of sterility. 

Treatment. — This will depend somewhat upon 
the previous health, and present condition of the 

* Denman's Midwifery, page 161. 



THIRTY YEARS OF FEMALE LIFE. 53 

patient. To relieve the pain, opium, in some form, 
is generally resorted to, and many times with good 
eifect ; yet as this drug, in any form, is apt to de- 
range the digestive organs, it is advisable to admin- 
ister it in the form of injection ; for this purpose, 
a tea-spoonful of laudanum in half a tea-cupful of 
thin starch, or warm water, will often give great re- 
lief ; and as a substitute for opium by the mouth, 
some other narcotic may be given, as hyoscyamus 
combined with camphor, three grains of each, in pill, 
at a dose, or digitalis and camphor. A mustard 
plaster, cloths wrung out of hot water or hot spirits, 
applied to the lower part of the bowels, will often 
relieve the pain ; also a hot sitz or hip bath. The 
tincture of black hellebore, in doses of about a tea- 
spoonful, in a wine glass of water, three or four 
times a day, has been used with good success by 
Dr. Meigs ; to be used during the interval between 
the periods. Many cases of painful menstruation 
depend upon a rheumatic affection of the womb ; 
when this is the case, ammoniated tincture of guiac, 
a favorite remedy of Dr. Dewees, will be of great 
service. Dose, thirty or forty drops, in a little 
milk, or sweetened water, three times a day ; com- 
mencing with ten or fifteen drops, and gradually 
increasing it every day until the full dose is reached. 
Preparations of iron, and other tonics, are sometimes 
indicated. Cathartic medicine will also be required, 
if the bowels are constipated. Bleeding from the 
lower part of the back, or loins, by cupping, or 
leeches, will be of service in some cases. If hvster- 



54 THIRTY YEARS OF FEMALE LIFE. 

ical, as nervous patients frequently are when afflic- 
ted with difficult menstruation, give ammoniated 
tincture of valerian, in doses of one or two teaspoons- 
ful, in sweetened water or flaxseed tea ; or tincture 
of lavender, or the compound spirits of lavender ; 
or one or two pills of assafoetida, or sulphuric ether, 
one teaspoonful, in sweetened water or flaxseed tea, 
three or four hours apart. Warm water, injected 
up the front or back passage, will frequently give 
relief; also, in cases subject to this painful malady, 
cold water, injected up the rectum two or three 
times a day, during the interval between the regu- 
lar periods, has frequently done much good. In 
some cases of painful menstruation, the passage 
through the neck of the womb is so contracted, that 
it prevents the flow from escaping to a great ex- 
tent, and the effort of nature to overcome this con- 
dition, gives rise to the pain. The treatment con- 
sists in dilating the passage, by introducing bougies 
of different size, just large enough to pass through 
the contraction with moderate force ; then after two 
or three days, if the first has not caused any par- 
ticular inconvenience, the next size larger may be 
used, and so on, until the passage is fully dilated. 
This infirmity is also remedied by making incisions 
in the neck of the womb with a cutting instrument 
constructed for this purpose. Marriage has been 
recommended as a cure for painful menstruation. 

^' There is a popular impression, that when the 
highest functions of the sexual system are brought 
into play, many ailments, previously troublesome, 



THIRTY YEARS OF FEMALE LIFE. 55 

are likely to cease, and it is beyond a doubt that, 
in some instances, marriage, and pregnancy, and 
child-bearing, are followed by these desirable 
results. I fear, however that the chances are the 
other way ; that the girl who suffers from dysmenor- 
rhoea (painful menstruation) will be likely to suffer 
more from it, after marriage, than she did before ; 
that the extreme sensitiveness of her uterine organs, 
will render marriage, in all sexual respects, a very 
painful condition ; that conception will be less like- 
ly to occur than in another woman, and that if it 
should, pregnancy and labor will be attended by 
far more than the usual amount of distress. '^^ 

There is no doubt that a great many cases of te- 
dious, difficult, and sometimes fatal child-birth, arise 
from an abnormal condition of the reproductive 
organs, caused by some neglect or mismanagement 
of the girl, at, or previous to puberty. If those 
having the care of young females, particularly 
mothers, were better informed in regard to the re- 
sults of over exertion, exposure to cold, wet feet, 
want of proper out-door exercise, and improprieties 
of dress, at, or before, the time of the first appear- 
ance of menstruation, many of the ills common to 
females at the present day, might be prevented. 

♦West OQ Diseases of "Women, page 73. 



56 THIRTY YEARS OF FEMALE LIFE, 



CHAPTER VII. 

PROFUSE MENSTRUATION. 

This difficulty, as the term implies, is a loss of 
blood at each menstrual period, greater than the 
system can aftord to lose with impunity. It is often 
attended with the formation of clots, which are ex- 
pelled with more or less pain, resembling, in this 
respect, the complaint previously considered. In 
fact, profuse and painful menstruation often exists 
as cause and effect. Yet, a woman may, and many 
do, have an excessive loss of blood at each period, 
without pain, occupying the usual time, or, it may 
be, extended over a period of eight or ten days; and 
some authors consider a flow extending nearly, or 
quite, from one period to an other, as excessive men- 
struation. But a discharge of this character, should 
be regarded as uterine hemorrhage, observing little 
or none of the, periodical form, which is peculiar to 
profuse menstruation. The general health of the 
person should be considered, also, before calling it 
too profuse, for what would be justly considered ex- 
cessive in one case, would not in another, though 
the quantity lost might be twice as much. A full, 
plethoric habit, would bear, with little or no incon- 
venience, a loss that would quite prostrate a weak, 
feeble woman. 



THIRTY YEARS OF FEMALE LIFE. 57 

When we consider the fact that menstruation is 
a secretion from the womb, by a process of period- 
ical congestion of its tissues ; that it is abundantly 
supplied with blood by two large uterine arteries, 
and also receives a considerable portion from the 
ovarian arteries, we should not be surprised to 
meet with cases of profuse menstruation oftener 
than we do. 

Profuse menstruation occurs under opposite con- 
ditions of the system. In one class of cases, there 
is a plethoric, full habit ; in the other, a weak and 
feeble condition ; in the former, not only the blood 
vessels of the w^omb are over distended, but there 
is a general fulness of the whole system. The pro- 
fuse discharge, under such circumstances, acts like 
a safety valve to the vessels, preventing serious 
congestion of some vital organ, and so long as the 
flow keeps within due bounds, calls for no treatment 
at our hands. In the other class of cases, the blood 
vessels are unable to resist the force of the blood 
circulating in them, from weakness or want of tonic 
action. When it comes on fiom a plethoric condi- 
tion of the system, it may return so often, and con- 
tinue so long, that an anaemic or bloodless condition 
is produced, persisting after the cause producing it 
in the first place has ceased. Frequent child-bearing 
and over nursing is sometimes a cause of excessive 
menstruation. Some women nurse their children 
longer than their constitution admits of, in order to 
prevent an increase of family ; the consequence is, 
they are so reduced that Avhen their courses come on, 



58 THIRTY YEARS OF FEMALE LIFE. 

it is excessive, prostrating them still more. It may 
also be caused by a polypus, congestion of the 
womb, ovarian iritation, misplacement, or irritable 
condition of the uterus. It is sometimes produced 
by scarlet fever, and other eruptive diseases ; by 
over excitement of the sexual organs, or any cause 
producing congestion of the pelvic organs. 

The symptoms are such as might be expected 
from an excessive discharge of blood, whether from 
the womb, or any other part of the organism. ^' Ex- 
haustion languor and dislike of exertion, weakness 
across the loins and hips, paleness of the countenance, 
headache, throbbing of the temples, ringing in the 
ears, and giddiness, occurs more or less in the slight- 
er cases. If the disease be not relieved, and espe- 
cially if uterine leucorrhoea be present, all these 
symptoms become aggravated. The exhaustion 
and languor increase, the face becomes sallow, an 
aching pain is felt across the loins, extending round 
the lower part of the abdomen, pain in the left side, 
repeated and severe headaches, the face becomes 
sallow, derangement of the stomach and bowels, in 
short, all the secondary symptoms, and the derange- 
ment of the health which follow in the train of 
anemia, no matter in what way this may be pro- 
duced.""^ 

Profuse menstruation is often induced by the fe- 
male getting up too soon after child-birth, and par- 
ticularly after a miscarriage ; from mental emotions, 

*Cburchill on Diseases of Women, page 133. 



THIRTY YEARS OF FEMALE LIFE. 59 

a fall or blow across the abdomen, and over exer- 
tion ; it may come on from taking cold, although sup- 
pression more frequently follows this cause ; yet by 
producing congestion of the womb, an excessive 
flow is sometimes the result ; also from ulceration 
and chronic engorgement of the womb. 

The treatment consists in building up the debili- 
tated and broken down constitution. If the female 
is nursing, the child must be weaned, and tonic med- 
icines administered, and as the patients are more 
or less chlorotic, the treatment recommended for 
that complaint, will benefit them in this. The ergot 
of rye, has been used with good success in many 
cases ; it may be given in doses of fifteen to thirty 
drops of the tincture in half a wine glass of water, 
or by making an infusion of the drug freshly pow- 
dered, or the following mixture, spirits of minderera 
one ounce, tincture of ergot half an ounce, tincture 
of digitalis two drachms, mix ; dose, a tea-spoonful 
every four or six hours. Elixir of vitriol, ten drops 
in a wine glass of water, two or three times a day ; 
alum water internally, and used as a sitz bath ; also, 
cloths wet in cold water and vinegar, applied to the 
lower part of the abdomen, and external parts. 
Injections of half a pint of cold water up the rec- 
tum three or four times a day, is of great service in 
many cases. Plugging the vagina may be required 
sometimes, and for this purpose, a piece of alum, 
about the size of an egg, may be used, first making 
it as smooth as It can conveniently be done, and 
then introduced up the vagina, where it can remain 



60 THIRTY YEARS OF FEMALE LIFE. 

for a day or two. Also, pieces of lint, or cotton 
wool, dipped in alum water, may be used in the 
same way as the piece of alam. 

If the evacuations from the bowels are clay color- 
ed, indicating torpidity of the liver, give three or 
four grains of blue mass, with two or three grains of 
extract of hyoscyamus, at a dose, at night ; or mer- 
cury and chalk, or calomel. By those who object 
to take any preparation of mercury, the following 
may be used as a substitute. Podophyllin, one 
grain, leptandrin, two grains, extract of dandelion, 
suiBScient to make into pill, to be taken for a dose, 
or the same in powder, mixed with syrup, without 
the extract. If the feet and legs swell, it may be 
necessary to bandage them ; sometimes bathing 
them in salt and water, night and morning, is bene- 
ficial. Some cases may require bleeding, either gen- 
eral or local, but it will be those only of a plethoric 
habit. Exercise in the open air, when the patient 
can bear it, also bathing, and friction with a coarse 
cloth, will aid much in the recovery of the patient's 
health. 



THIRTY YEARS OF FEMALE LIFE. 61 



CHAPTER VIII. 

UTERINE HEMORRHAGE. 

This complaint dilBfers from profuse menstruation, 
by being a more or less continuous discharge of 
blood from the womb, unaffected by the periodical 
influence observed in the latter complaint, except, 
in some cases, it may be aggravated every three or 
four weeks. It may continue for months or years. 
Dr. Meigs mentions a case, where a bleeding from 
the womb continued for six years and a half, caused 
by a uterine polypus. Other tumors of the womb 
often produce the same effect. It is an affection to 
which females are liable at any period of life, hav- 
ing been observed in girls at puberty, and even be- 
fore this period. At the turn of life, it is not rare 
to meet with cases of hemorrhage of a very active 
character. The time of its greatest prevalence, 
however, is during the child-bearing age, and some- 
times occurs during pregnancy, and not unfrequent- 
ly results from abortion. 

In most cases, the womb is in a state of engorge- 
ment, much larger and heavier than natural, the 
servix or neck considerably enlarged, and soft to 
the touch ; the os, or mouth of the womb, patulous 
and open, so as to admit the end of the finger to 
the first joint. Misplacement of the organ is often 



62 THIRTY YEARS OF FEMALE LIFE. 

observed in this complaint. In other cases, more 
rare than the former, the neck of the womb is not 
only greatly enlarged, but it is also hard and car- 
tilaginous. The symptoms are such as might be ex- 
pected from a constant drain, or seaping away of 
the vital fluid, namely, great weakness and prostra- 
tion, pale, bloodless countenance, cold hands and 
feet, more or less painful dragging sensations 
through the pelvis and lower part of the body, pain 
in the back and limbs, hysteric symptoms, and pain 
or dizziness in the head. In some cases, the dis- 
charge nearly or quite ceases, when the patient is 
in a recumbent posture, bat as soon as she gets up- 
on her feet, it make its appearance again. It is in- 
creased by going up and down stairs, sweeping, or 
lifting a weight of only a few pounds. 

The treatment consists in improving the general 
health by tonic medicines, as compound tincture of 
Peruvian bark, and compound tincture of gentian, 
an ounce of each. Dosq^ one or two tea-spoonsful 
in a little water, two or three times a day ; ten 
grains of quinine, and ten grains of sulphate of 
iron, made into ten pills, with extract of gentian, or 
extract of dandelion, one pill twice or three times a 
day ; a tea of hops or chamomile flowers, or both 
together; muriated tincture of iron, in ten or twelve 
drop doses, in a wine-glass of water, three times a 
day, increasing by one or two drops each day, until 
twenty or thirty is reached. Dr. Meigs recommends 
the roots of the black currant and dewberry, a hand- 
ful of each, boiled in two quarts of water. Dosey 



THIRTY YEARS OF FEMALE LIFE. 63 

half a cupful occasionally ; tincture of ergot, half an 
ounce, tincture of digitalis, two drachms, water one 
ounce. Dose^ thirty or sixty drops, three or four 
times a day. " Five or twenty grains of powdered 
alum, with two grains of nutmeg, made into a pow- 
der and mixed in syrup, is a good dose, to be repeat- 
ed hourly."* 

Cloths wet in cold water and vinegar, applied to 
the lower part of the abdomen, are often of service ; 
also half a pint of cold water, injected up the rec- 
tum, three or four times a day, will frequently check 
the bleeding. A solution of sulphate of zinc, sulph- 
ate of iron, or nitrate of silver, may be injected into 
the Avomb, with great advantage in some cases. 

As uterine hemorrhage depends upon engorge- 
ment of the organ, in most cases, that condition 
must be overcome before a permanent cure can be 
effected. Small bleedings from the arm, repeated a 
number of times, has a favorable result in many cases, 
by directing the blood away from the uterine ves- 
sels, producing a revulsive action. The recumbent 
posture should be observed until out-door exercise 
can be safely recommended ; it will then be of ad- 
vantage, by increasing the strength ; also a cold 
hip or sitz bath, with friction by means of a coarse 
cloth. Cathartics are often required, but they 
should be of a mild, unirritating class. 

* Meigs' Diseases of Women, page 468. 



64 THIRTY YEARS OF FEMALE LIFE. 



CHAPTER IX. 

LEUCORRHCEA. 

This disease, known among women as the whites, 
or inward weakness, is an exceedingly common 
complaint. No period of female life can be said to 
have an immunity from it, and very few, at the pre- 
sent day, but are or have been, at some period of 
their lives, affected with it. Although most fre- 
quently met with at some period during the thirty 
years of menstrual life, yet some are afflicted with 
it after menstruation has finally ceased. It is also 
often observed in girls about the age of puberty, and 
in some cases several years previous to this period. 

This complaint has received the name of whites, 
yet it often assumes a different color, being some- 
times of a yellowish straw color, or it may be of a 
brownish or greenish hue, with slight streaks of 
blood. When it is what the term implies, strictly 
speaking, it resembles the white of an egg — a thin, 
glairy fluid, keeping the external parts uncomfortably 
moist. It may, at times, be so abundant as to re- 
semble the monthly flow in quantity, compelling 
the person to protect herself with cloths, as though 
she was menstruating. When it assumes the yel- 
low or greenish color, it produces stains upon the 
clothing like matter from a sore. In this form of 
the complaint, if the female is married, she is liable 



THIRTY YEARS OF FEMALE LIFE. 65 

to communicate a disease to her husband, similar in 
its nature, and requiring similar treatment to gonor- 
rhoea, or bad disorder. This important fact has 
been overlooked, as a general thing, heretofore. 
The consequence is, many serious family troubles 
have been the result ; innocent parties having 
been wrongfully accused of incontinence. 

Leucorrhoea is frequently observed in chlorosis, 
or may assist greatly in producing that complaint ; 
it is also connected with most of the abnormal con- 
ditions of the ovaries and womb. By medical wri- 
ters, leucorrhoea is divided into vaginal and uterine, 
as it sometimes proceeds from the vagina alone, at 
others from the womb, or it may be both uterine and 
vaginal at the same time. 

" When the discharge is constant, profuse, and of 
long standing, exhaustion and degradation of the 
constitution is soon found to be the unfortunate and 
necessary result of this flux, which never ceases,"- 
and which seems to attract to itself the sources of 
all the other excretions, and thus to cause a drain 
upon the whole economy. The skin now becomes 
more and more discolored, the emaciation increases, 
the flesh becomes loose, the breasts are soft, the 
pulse small and frequent, and the breath foetid ; the 
eyelids become bloated, the legs are always cold, 
and the whole body sometimes becomes oedem- 
atous."^ 

The patient also complains of more or less pain 
in the back, and through the lower part of the bow- i 

*Colombat on Diseases of Females, page 317. 



66 THIRTY YEARS OF FEMALE LIFE. 

els ; a dragging, bearing down sensation, particu- 
larly if obliged to be much on her feet ; a scald- 
ing or burning sensation on passing water ; weak- 
ness in the back and knees ; more or less pain in the 
head ; appetite variable, sometimes none at all, at 
others the patient wants to eat a number of times 
during the day ; the bowels are irregular, itching 
of the external parts, pain in one or both shoulders, 
weakness and distress across the stomach. Many 
cases are troubled with a cough, slight at first, but 
gradually increases, finally terminating in consump- 
tion. It is frequently the case that women sufi'er 
from leucorrhoea for months or years, under the im- 
pression, many times, that it is only one of those 
inconveniences natural to the female organs, and 
for which there is no use to seek relief ; others, 
again, are aware of its weakening influence, yet 
from that delicacy peculiar to the sex, prefer to 
suffer from it, rather than let their complaint be 
known ; the consequence is, if they are married, 
and have female children, the weakness is often 
transmitted to them, so that Ave see the evil effects 
not only on the health of the mother, but the child 
inherits a Aveakly constitution, and often the same 
complaint, from the same cause. The effect of a 
weakness like this, taking away the vitality of the sys- 
tem, prostrating the nervous organization, and sap- 
ping the foundations of health, should not be neglec- 
ted ; years of suffering, terminating in serious, if not 
fatal organic disease, have proceeded, in many in- 
stances, from a simple ailment, easily cured, if taken 



THIRTY YEARS OF FEMALE LIFE. 67 

in season. In fact, it is more than probable that a 
great part of the suffering of which women complain, 
might be prevented; if they were better informed 
in regard to their diseases, their symptoms, and the 
proper treatment. 

The object of this work is to furnish that infor- 
mation on the diseases, peculiar to the sex, so long 
needed. It is not reasonable to expect that a 
weakly woman will bring forth strong, healthy 
children, especially if they partake of her constitu- 
tion, which is often the case. The same remarks 
apply also to the father. If the seed is unhealthy, 
so must the product be also. A bitter fountain can- 
not bring forth sweet waters. 

The question is often asked, why is it that so 
many children die in infancy ? the answer is, many 
of them inherit a weakly constitution from their 
parents ; they live a few months, suffer and die. 
Who is to blame ? Ask the countless thousands, 
that have gone to an early grave, before they were 
able to lisp a parent's name. What is it that causes 
scrofula and consumption? complaints causing 
more suffering and death, than all the other diseases 
combined. The answer is, hereditary transmission, 
handed down from parent to child, as a legacy of 
suffering. How often has the remark been made, 
" before my child was born, I was considered in a 
consumption ; my health was miserable, now I am 
better than I have been for years.'' Better, at the 
expense of the health and happiness of her off- 
spring. 



68 THIRTY YEARS OF FEMALE LIFE. 

Persons are occasionally met with, who believe 
that weakly children can be toughened, or made 
strong, by exposure ; and to substantiate their 
assertion, refer to the Indians and other hardy races, 
who live a life of exposure and hardship ; but they 
seem to forget the important fact, that if a weakly 
child is born to such parents, it invariably dies, 
as none but those possessing a hardy constitution 
are able to bear the exposure necessary to such a 
mode of life. 

The treatment of leucorrhoea consists in reliev- 
ing the debility, and arresting the discharge. Ton- 
ics are indicated to restore the enfeebled powers, 
and such as have been recommended for the debil- 
itated condition resulting from chlorosis, may be 
resorted to with advantage. Applications to the 
external parts, and injections up the vagina of warm 
water, or milk and water, will frequently relieve 
the smarting and itching sensation often experi- 
enced in this complaint ; also, the spirits of nitre, 
dose a tea-spoonful in one or two table-spoonsful of 
water, three or four times a day. If the discharge 
still continues, more active remedies are required, 
as the sugar of lead wash, solutions of alum, or sul- 
phate of zinc, one or two drachms in a quart of 
water, or nitrate of silver three or four grains to 
the ounce of water, also sulphuric acid, twenty drops, 
in a quart of water, injected up the vagina, in quan- 
tities of two or three table-spoonsful, two or three 
times a day, has often cured the complaint. 

If the discharge proceeds from the womb, the 



THIRTY YEARS OP FEMALE LIFE. 69 

same solutions may be injected into it, that have 
been recommended for the vaginal discharge ; but 
in regard to using injections into the cavity of the 
uterus, there is considerable diversity of opinion, 
among medical writers^ as to the propriety of the 
treatment. That bad effects have followed their 
use, in some cases, there is no doubt, yet such re- 
sults can be prevented by taking proper pre- 
cautions. 

As there is little probability of finding the pas- 
sage through the neck of the womb unnaturally 
contracted from the nature of the ailment, an in- 
strument should be used, small enough to let the fluid 
injected in, pass out, as rapidly as it was thrown 
into the cavity ; in this way avoiding the disten- 
sion of the organ, which would result if the instru- 
ment was so large as to fill the passage, and not al- 
low the fluid to escape. A gum elastic catheter, of 
suitable size, makes a very convenient instrument, to 
which the point of a small syringe is to be attached. 
There should not be much force used, as a want of 
this precaution alone, might cause considerable 
pain. The quantity of fluid made use of, should be 
in accordance with the size or capacity of the 
womb ; one or two drachms would not cause pain 
from over distension, even if the solution did not 
escape until the instrument was removed, and if the 
organ was enlarged, and its capacity increased, the 
quantity injected might be increased accordingly. 
Another important point is, to use the solution warm 
instead of cold, as is usually done, and as a further 



70 THIRTY YEARS OF FEMALE LIFE. 

precaution, try the effect of simple warm water first. 
If this plan is adopted, no ill effects will follow the 
administration of uterine injections. 

That perotineal inflammation can result from mo- 
derately injecting a fluid into the uterus, in conse- 
quence of some portion of it passing into the pero- 
tineal cavity, through the fallopian tubes, is far from 
probable, if we take into consideration the fact, 
that the womb is often enormously distended with 
water, in dropsy of that organ, without this result 
following. If the patient is of a plethoric habit, 
bleeding, either general or local, may be necessary; 
some cases are benefited by a blister, applied to 
the lower part of the spine ; also by cold or salt 
water bathing, sponging, or showering the back, to- 
gether with friction with a coarse cloth. 

When young girls are the subjects of this disease, 
the parts should be bathed with warm water and 
and milk, or a decoction of marsh-mallows, sugar of 
lead, a weak solution of sulphate of zinc, or nitrate of 
silver, one or two grains to the ounce of water. It is 
sometimes necessary to inject up the vagina, with a 
small syringe, some of the solutions just mentioned. 
This discharge, even when it attacks young girls, 
sometimes assumes a yellowish straw color, staining 
the linen, which is often the first thing that directs 
the attention of the mother to the ailment, and be- 
ing unacquainted with the fact that lucorrhoea in 
children often occurs, supposes immediately that 
some one has commited a rape on the girl, or at 
least, attempted it ; takes her aside, questions her 



THIRTY YEARS OP FEMALE LIFE. 71 

as to where she has been, and what boy has offered 
her violence. The girl, knowing that nothing of the 
kind has happened, denies that any one has at- 
tempted to wrong her. She is not believed, her 
mother knows she is telling a lie, threatens her with 
severe punishment, if she does not tell her who it 
is, but she still denies. After being severely chas- 
tised, and threatened with still greater punishment, 
at last, through fear, actually tells that which she 
knows to be false, and the crime is charged upon 
some boy she may chance to think of, who is imme- 
diately arrested, and tried for an offence of which 
he is perfectly innocent. An instance is given in 
Percival's Medical Ethics, of a boy who was near 
suffering capital punishment for this supposed 
offence, and saved merely by the occurrence of 
other cases, concerning which no suspicion could 
exist. The presence of this discharge is no proof 
whatever of such an offence, which must be prov- 
ed by evidence totally independent of it. 

"A girl, seven years of age, was brought by her 
mother to Dupuytren's consultation, for his advice 
respecting what she thought were the effects *of 
violence committed on her child. There was a 
copious yellow colored discharge from the vagina, 
and the labia were red, swollen and painful. No ex- 
coriation or laceration, however, was to be per ceived, 
and the hymen remained perfect. Dupuytren as- 
sured the parents that the cymptoms by no means 
justified the suspicion which they entertained ; he 
could not say, positively, that no attempt had been 



72 THIRTY YEARS OF FEMALE LIFE. 

made to injure the child, but only that the existing 
symptoms might arise from other causes. Indeed, 
so frequent are cases of this description, at particu- 
lar periods, that some have suspected that they 
might depend upon some epidemic influence." In 
another similar case, "Dupuytren regarded the 
case as one of catarrhal inflammation of the 
genitals, and predicted at the time, that in all prob- 
ability, several cas es of a similar nature would pre- 
sent themselves to his notice in the course of the 
week, and so it was ; they were all treated success- 
fully with tepid baths, emollients, and soothing 
washes."* 



CHAPTER X, 

OVARIAN INFLAMMATION. 

It is now generally conceded that the ovaries are 
the principal organs concerned in menstruation ; 
that by their influence, the uterus is stimulated to 
act. If then, we bear in mind the position of the 
ovaries, and their relation to other important organs 
within the pelvis, also the fact, that at each monthly 
period their vascularity is increased, and they be- 
come more or less congested, we should not be sur- 
prised to often find them in a diseased condition. 
Dr. Ashwell says " Of all the organs of the human 

*CliurchiU on Diseases of Women, page 66. 



THIRTY YEARS OF FEMALE LIFE. 73 

body, scarcely any seems so prone, either to func- 
tional or organic disease, as the ovaries ; for I 
can with truth say, that I have rarely, when exami- 
ning these important organs after death, found 
them entirely healthy."^ 

If, as Dr. Ashwell observes, in examinations af^er 
death, he has rarely found them entirely healthy, it 
is more than probable that they are often in an ab- 
normal condition, and the symptoms arising there- 
from have been referred to the uterus^ and treated 
accordingly. 

Ovarian inflammation is usually divided into an 
acute and chronic form, according to its advent, 
whether coming on suddenly, as after abortion or 
child-birth, and sudden suppression of the milk, or 
lochial discharge, or at other periods, from sudden 
suppression of menstruation, from cold, and other 
causes, or as it proceeds from the acute form. Also, 
coming on gradually, without any particular symp- 
toms marking its commencement, the latter form is 
much oftener met with than the former. It some- 
times exists without the uterus being implicated, as 
cases have been examined, after death, where one or 
both ovaries were in an abnormal condition, and the 
womb was found to be healthy ; more commonly, 
however, the reverse is the case ; in fact, there is 
little doubt that most cases of painful and other- 
wise faulty menstruation, together with other uter- 
ine complaints, is due, in a great measure, to chron- 
ic inflammation of the ovaries. 

*Page 6, 3d Editioa. 



74 THIRTY YEARS OF FEMALE LIFE. 

Among the causes capable of producing this com- 
plaint, may be enumerated, difficult parturition, the 
use of obstetric instruments, inflammation and 
misplacement of the womb, a fall or blow across the 
abdomen, exposure to cold during or just before 
menstruation, or the means made use of to check 
uterine hemorrhage. 

" Marriage late in life, is sometimes of itself a suf- 
ficient cause of sub-acute overitis. The privation 
of sexual stimulus is, no doubt, a cause of certain 
forms of sub-acute overitis, (chronic inflammation.) 
Also those excitements which tend to, exaggerate the 
impulse of unsatisfied desires, which, though natural 
in themselves, have been pampered by bodily and 
mental inactivity, and unduly excited by thoughts, 
books, pictures, conversation, music, and the fascina- 
tions of social intercourse.*^* 

Symptoms. — Pain in the lower part of the abdo- 
men, between the hip and lower ribs, affecting one 
or both sides ; in the majority of cases only one side 
is complained of, and that the left ; and in a num- 
ber of cases, when the disease attacked both ovaries, 
the patients have complained of pain in the left side 
first. 

'' The patient experiences a dull pain in the 
ovarian region, often imperceptible when she is in 
a state of repose, but brought on by walking, riding, 
any sudden movement, or even by pressure on the 
side. The pain is also increased by the act of 
straightening the thigh upon the pelvis, as in the 

*Tilt on Menstruation, page 90 and 91. 



THIRTY YEARS OF FEMALE LIFE. 75 

erect posture, by which the integuments are put 
upon the stretch, and pressure is thus exerted over 
the part. Some patients are unable to maintain the 
erect posture, without resting the foot of the side 
affected on a stool, so as to keep the thigh more 
or less bent upon the pelvis. Radiating from the 
ovarian region, the pains are felt across the loins ; 
then descend towards the thighs and fundament, 
and are of a dull, dragging, and sometimes of an 
overwhelming nature. They are distinguished by 
the patient, from other pains resembling colic, and 
which depend on uterine contractions, although both 
species of pain may be experienced at the same 
time."* 

There is frequently much irritability of the 
bladder, the patient being unable to retain more 
than a small quantity of water at a time, and the 
evacuation of it occasionally attended with much 
pain and stranguary. A movement of the bowels 
increases the distress. In some cases, the pain ex- 
tends upwards, and is felt all along the space be- 
tween the hip and lower ribs ; it is sometimes de- 
scribed as a burning pain, very circumscribed, ap- 
pearing to occupy a spot, not larger than a shilling 
piece. In most cases, where the pain is due to in- 
flammation of the ovaries, it is increased by pres- 
sure ; when of a neuralgic character, this is not 
the case. 

Chronic inflammation of the ovaries is often insi- 
dious in its advent, coming on imperceptibly, and 

*Tilt on Menstruation page 113. 



76 THIRTY YEARS OF FEMALE LIFE. 

may exist for years without producing very marked 
symptoms, until some favorable condition of the 
system presents itself, as child-birth, or abortion ; 
it then assumes a form not easily mistaken. At 
other times, the first indication of abnormal action 
is more or less pain, often but slight, at each month- 
ly period ; this is gradually increased, until the pains 
not only become of a more violent nature at each 
period, but continue from day to day, the patient 
not being free from it from one period to another. 
There is sometimes an enlargement, just above the 
groin, where the severest pain is frequently com- 
plained of, also an inward fullness and pressure 
within the pelvis. 

Treatment. — Half a dozen or more leeches ap- 
plied over the seat of the pain ; if the attack has 
come on suddenly, general bleeding from the arm may 
be resorted to first, with great advantage many times; 
also blisters and hot fomentations, such as hops, 
some herb tea thickened with Indian meal, so as to 
make a kind of poultice, and laid on the affected 
part, as hot as the patient can bear it, and renewed 
from time to time, when it becomes cold ; two or 
three thicknesses of flannel, wrung out of hot water, 
or hot spirits, may be used the same as the poultice. 
Opium, laudanum and morphine is given with good 
effect, but as they do not suit all constitutions, some 
other narcotic might be substituted, as hyoscyamus, 
and tincture of digitalis ; or the following combina- 
tion will be found of great service in the majority 
.of cases. Hyoscyamus, twenty grains, pulverized 



THIRTY YEARS OF FEMALE LIFE. 77 

camphor, twenty grains, make ten pills. Dose^ one 
or two pills, four or six hours apart ; or camphor 
mixture Avith tincture of hyoscyamus and tincture 
of digitalis ; bathing the affected parts with spirits 
of camphor and laudanum ; also, camphor liniment, 
one ounce, extract of belladonna and extract of hy- 
oscyamus, one drachm of each, either solid or fluid, 
to be well rubbed in ; an anodyne plaster to the 
lower part of the back ; small doses of calomel and 
opium ; the mercurial ointment, two ounces, iodide 
of potassium, one drachm, iodine, ten grains, mixed 
together, will be found a valuable remedy ; let a 
piece, the size of a small hickory nut, be well rub- 
bed into the affected part, night and morning ; cold 
water injected up the rectum, four or five times a 
day, in quantities of about half a pint, continued for a 
number of days, will often reduce the inflammatory 
action. The pain will be greatly relieved by using 
an injection of half a tea-cupful. of water, and a tea- 
spoonful of laudanum, or one or two tea-spoonsful 
of spirits of camphor. The action of these medi- 
cated injections will be readily understood, if we re- 
member, that the inflamed ovary is in close proximi- 
ty to the rectum. The patient should, therefore, be 
instructed to retain the injection as long as she 
can conveniently. It is probable that some portion 
of these medicated injections reaches the ovaries by 
absorption, if they are retained a reasonable length 
of time ; yet, aside from this, Vv^e should expect bene- 
fit from them, from their influence on the sacral 
nerves. Counter irritation over the affected ovary, 



78 THIRTY YEARS OP FEMALE LIFE. 

by means of a mustard plaster, or tartar emetic 
ointment, is sometimes beneficial. If the bowels are 
in a condition requiring cathartics, such as act 
harshly on the rectum should be avoided ; for this 
purpose, the following mixture may be taken, or 
some other saline preparation ; sulphate of magne- 
sia and tartarized soda, one ounce of each, water, half 
a pint. Dose, a wine-glassful, two or three times a 
day, or until the bowels are acted upon, then by 
taking a table-spoonful occasionally, they will be 
kept open. The general health will require atten- 
tion, and such tonics as have been previously re- 
commended in like conditions of the system, may be 
resorted to. 



CHAPTER XI. 

ENGORGEMENT AND CONGESTION OF THE WOMB. 

Before the age of puberty, the womb is rarely 
attacked with disease. Previous to this period, it 
remains, as it were, dormant, possessing little vitali- 
ty in common with other organs and tissues. 

^'Isolated as it were from the rest of the organiza- 
tion, and exerting only a feeble influence upon the 
different organic apparatus, the uterus is, itself, 
rarely affected sympathetically during the early pe- 
riod of life. Being, by its anatomical position, pro- 
tected from the mechanical, physical or chemical 



THIRTY YEARS OF FEMALE LIFE. 79 

action of exterior bodies, it is little exposed to acci- 
dental maladies, and, therefore, examples of diseases, 
and especially of organic alterations, are extremely 
rare in infancy. But when the period of puberty 
arrives, announcing itself by a more rapid develop- 
ment of the whole economy, and a greater activity 
of all the functions, the entire life seems to be ani- 
mated with a new fire, the organs of generation 
participate in the effect of the general movement, 
or indeed, it is only at this time, that their existence 
may be said to begin. The uterus then leaves the 
state of inertia in which it had, as it were, been bu- 
ried, henceforth to play an important role. Its tis- 
sue becomes permeable, extensible, and even erec- 
tile. Blood circulates more freely through it ; its 
sensibility is developed ; it becomes the centre and 
point of departure of sympathetic irradiation, which 
subject to it all the acts of the economy, and these 
in their turn, exercise influences not less important 
in the proper functions of this organ."* 

After the age of puberty, of all the organs of the 
body, there is none more liable to disease than the 
womb, be the female married or single, although 
pregnancy, and it^ consequences, produces more or- 
ganic and functional diseases than any other cause, 
and no organ produces snch a train of sympathetic 
affections, when in an abnormal condition. We 
shall not be surprised at this, when we consider the 
fact, that it is abundantly supplied with nerves from 
the great sympathetic nervous system, and that at 

*Duparcque on the Uterus, page 22. 



80 THIRTY YEARS OF FEMALE LIFE. 

each monthly period, it becomes more or less con- 
gested, or engorged with blood, which relieves it- 
self, by producing the courses. Everything con- 
nected with menstruation being normal, the month- 
ly evacuation passes off with little or no disturbance 
of the system ; but should anything occur, to inter- 
fere with the healthy performance of this function, 
as taking cold for instance, a great change is obser- 
ved ; the bloodvessels of the womb increase in size, 
distending, more or less, the body of the organ ; it 
becomes larger and heavier, producing engorge- 
ment or congestion ; the nerves are pressed upon by 
the distended vessels, causing, and Avith the in- 
creased weight of the organ, producing the symp- 
toms of painful menstruation. 

'' In the early periods of puberty, the uterus is 
not always in a condition to emit the fluid that 
gives rise to the menstrual movement in its tissue. 
In consequence of which, a local plethora or conges- 
tion occurs, manifested by a sense of heaviness in 
the hypogastrium, more or less severe pains, denom- 
inated uterine colic, or uterine tenesmus, alternate 
chills atid flushes, headache, difficult respiration, and 
sometimes hysteric fits. This fluxionary movement 
having existed a few hours or days, subsides sponta- 
neousl)", without any discharge ; it reappears, with 
the same symptoms, at the following menstrual pe- 
riod, until the exhalent extremities of the vessels, 
becoming more permeable, readily disgorge them- 
selves. In some girls, however, this state of things 
continues through an indefinite period ; the conges- 



THIRTY YEARS OF FEMALE LIFE, 81 

tion of the uterus does not completely pass off, 
after each period, but becomes increased, the local 
and general disturbance acquires intensity, and 
medical aid is required to prevent the dangerous 
consequences of this morbid state. 

The engorgements of the uterus may, under these 
circumstances, take on the form of simple congestion, 
of acute and particularly chronic inflammation, 
which may successfully, or simultaneously, pass 
through all the stages of suppuration, or cartilagi- 
nous or osseous degenerations. Restricted in the 
degree of its action, this engorgement becomes 
the basis of cancerous formation, in the course of 
some years.'^^ 

Notwithstanding the compactness of the tissues 
of the womb, previous to pregnancy, we sometimes 
observe this organ, even in young females, very 
much enlarged from engorgement, equalling in size 
the impregnated womb of three or four months, for 
which it might be mistaken, were it not for the 
pain, tenderness, and other indications, which should 
be carefully noted, before forming an opinion. In 
most cases of chronic engorgement of the womb, 
there is more or less inflammation, which, at first, 
assumes the acute form ; after a time, the acute 
stage passes off, leaving the organ enlarged, and 
painful to the touch, in which condition it is most 
usually met with. It may also exist independently 
of an acute attack, coming on imperceptibly, and 
continuing for years, with occasional aggravation of 

*Duparcque on the Uterus, page 23 and 24. 



82 THIRTY YEARS OF FEMALE LIFE* 

the symptoms, particularly after exposure to cold, 

or at a monthly period* The disease is sometimes 
confined to the body of the womb ; more commonly, 
however, the neck is in the same condition, and may 
be the first part attacked, the engorgement spread- 
ing to the other portions of the organ. As before 
remarked, this condition of the uterus may continue 
any length of time, resulting in ulceration of the 
mouth and neck of the womb, hard engorgement, or 
induration, and cancer. This latter complaint is 
particularly apt to manifest itself abouj. the time of 
the cessation of menstruation. 

Causes. — It often follows an acute attack of in- 
flammation of the womb, also of the ovaries, a 
scrofulous habit, frequent child-births and abortions, 
faulty menstruation, forcing medicines used to bring 
on menstruation, a cold taken during or just previous 
to menstruation, improper use of cold astringent in- 
jections to check the whites, the use of instruments 
to produce miscarriage, getting up too soon after 
delivery, too much force used in removing the after- 
birth, a sudden misplacement of the womb, immod- 
erate sexual intercourse, forced celibacy, veneral 
virus, or constipation. It sometimes comes on with- 
out any known cause. 

Symptoms. — In consequence of the increased size 
and weight of the womb, there is more or less mis- 
placement of the organ, characterized by a sense of 
fullness in the pelvis, and bearing down, pain in the 
region of the womb, extending to the groins and 
thighs, also the lower part of the back ; it may be 



THIRTY YEARS OP FEMALE LIFE. 83 

constant, or aggravated from time to time. Some 
complain of a burning pain when they are in a re- 
cumbent posture. Disorders of the menstrual func" 
tion is often observed ; if it comes on at the regular 
period, it is frequently of shorter duration and paler 
than natural ; in other cases, the flow is suppressed 
for a number of months, reappearing in a hemorr- 
hagic form, and lasting two or three weeks, accom- 
panied with symptoms of painful menstruation ; 
between the monthly periods, there is more or less 
leucorrhoeal discharge. Sometimes, however, the 
reverse of this is the case, the vagina being hot 
and dry ; at other times, the discharge is of a dis- 
agreeable odor. Itching of the external parts, is a 
troublesome symptom, in some cases. The bowels 
are often constipated, and when a movement takes 
place, the pain is greatly aggravated. The urinary 
organs are often affected, there being in some cases, 
a frequent desire to pass water, Avhich is accompa- 
nied with a smarting and otherwise disagreeable 
sensation about the neck of the bladder ; there is 
more or less derangement of the stomach, as nausea 
and vomiting. 

Some patients complain of a pain in the top of 
the head, the breasts are often tender and painful. 
In some constitutions, the sympathy between the 
womb and other parts of the organism, is abnormally 
acute, in others, the oj)posite condition is observed ; 
we therefore meet with cases where serious uterine 
difficulties exist, without the person being aware of 
it from any particular disturbance of the system ; 



84 THIRTY YEARS OF FEMALE LIFE. 

others again, will suffer exceedingly from a slight 
difficulty. 

Treatment. — In most cases, six or eight leeches, 
applied to the uterine region, will have a good 
effect, to be repeated if necessary ; hot fomentations 
to the bowels, a hot sitz bath, or a bUster on the 
lower part of the bowels, also, frictions with tartar 
emetic ointment ; mecurial ointment, or Iodide of 
potassa half a drachm, iodine ten grains, lard or me- 
curial ointment one ounce, a piece the size of a 
small hickory nut well rubbed in once or twice a day. 
Injections up the rectum, of water, half a tea-cup- 
ful, and thirty or forty drops of laudanum, or a tea 
made of poppy heads, to relieve the pain. Injec- 
tions of cold water, continued for a number of days, 
or four grains of iodide of potassa in about four 
ounces of water, twice or three times a day, has 
been found of great ser^ace in reducing the en- 
gorgement ; by using this small quantity of water, 
the patient will be able to retain it longer. As- 
tringent injections up the front passage may be 
resorted to if the acute inflammatory stage is passed ; 
for this purpose, solutions of tannin or sulphate of 
zinc may be used : as the neck of the womb is gen- 
erally more or less affected, the solid nitrate of sil- 
ver, applied to it freely once a week, will have a 
good effect, or a solution of twenty to thirty grains 
of nitrate of silver, in half a pint of water, one 
or two ounces of this may be injected up the 
vagina night and morning ; leeches applied to the 
neck of the womb will often produce a favorable 



THIRTY YEARS OF FEMALE LIFE. 85 

If the patient is of a full habit, repeated bleed- 
ings from the arm maybe indicated. Internally, er- 
got has been used with very favorable results in 
many cases, as fifteen or twenty drops of the tinc- 
ture, or eight or ten grains of the freshly powdered 
drug, three or four times a day ; also the following 
mixture : — iodide of potassa, half a drachm, extract 
of dandelion, two drachms, tincture of Peruvian 
bark, or tincture of gentian, two ounces. Dose, a 
tea-spoonful, three times a day, in two or three 
table-spoonsful of water, before eating. The gener- 
al health should be attended to, the relish for food 
and strength improved, by such tonics as have been 
previously recommended in like conditions, with 
iodide of iron, and others of this class. The bowels 
should be kept open by gentle laxatives, as citrate 
of magnesia, or the following mixture : — sulphate of 
magnesia, one ounce, cream of tartar, one ounce, 
water, one pint. Dose, two or three table-spoonsful, 
night and morning, or according to the effect. 



86 THIRTY YEARS OF FEMALE LIFE. 



CHAPTER XII. 

ULCERATION OF THE WOMB. 

The mouth and neck of the womb is covered by 
a mucous membrane, continuous with that which 
lines the cavity of that organ, and like all mucous 
surfaces, may become ulcerated. Yet an ulcer of 
these parts, according to the strict definition of the 
term, does not occur so frequently as is generally 
supposed, if we except syphilitic contagion, or can- 
cerous degeneration. Cases are often met with, 
however, that have been treated for ulceration of 
the womb, when no ulcer existed ; abrasion, or ex- 
coriation, a condition very often observed in chronic 
engorgement, having been mistaken for, or consid- 
ered actual ulceration ; and there is no doubt, but 
that an excoriation of the mouth of the womb, may, 
under favorable circumstances, finally result in ero- 
sion, which may be considered the simplest form of 
ulceration. By favorable circumstances, is meant a 
continuation of the engorgement, or congestion of 
the uterus. 

^' When the erosion of the neck of the uterus, such 
as we have described, is for a certain time left to it- 
self, or when it is for a long time submitted to the 
deleterious influence of exterior causes, as, for exam- 
ple, uncleanness, venereal excesses, or repeated par- 
turition, it is transformed into profound ulceration, 



THIRTY YEARS OP FEMALE LIFE. 87 

accompanied by a loss of substance. In place of 
the erosion, which at first, scarcely presented a sensi- 
ble depression, we see developed numerous globular 
vegetations, scarcely of the size of the head of a 
pin, sometimes very close together, sometimes wide- 
ly separated from each other/^^ 

This form is called granular ulceration, and con- 
sists of an engorgement, or hypertrophy of the lit- 
tle glands about the neck of the uterus. Ulceration 
of the womb, depends upon inflammation of that 
organ, either chronic or acute, most commonly the 
former ; and the symptoms, probably, are due more 
to the condition the womb is in, than to the ulcera- 
tion, for it would be rare indeed, to find an ulcer- 
ated womb, in every other respect healthy. The 
symptoms, therefore, will resemble to a greater or 
less extent, those of chronic engorgement, and as in 
the previous difficulty, owing to some peculiarity of 
constitution, it may continue for a long time, with- 
out producing any great disturbance of the organ- 
ism ; usually, however, there is " pain in the back 
and loins, much increased by the erect posture, by 
exercise and constipation, extending around the pel- 
vis, with sense of bearing down, internal heat, and 
frequent irritability of the bladder. She has, occa- 
sionally, pain on sitting down, and other symptoms, 
as in inflammation of the os and servix ; the cata- 
menial periods are either too profuse, or are irregu- 
lar and frequent, and during the intervals, there is 
more or less muco-purulent discharge. The health 



*ScanzQni on Diseases of Females , page 219. 



88 THIRTY YEARS OF FE^IALE LIFE. 

begins to fail ; she grows pale, sallow and feeble ; 
the digestive organs are deranged, and besides 
showing the usual appearances of this condition, the 
tongue has a rough, short napped fur upon it, which 
is characteristic of co-existing irritation. On exam- 
ination, per vaginum, the os uteri is low in the pel- 
vis, swollen, hard and tender, the mucous membrane 
is soft, and thicker than ordinary, so that, as in an 
irritable breast, it is easy to distinguish the soft 
covering from the indurated glandular tissue be- 
neath ; the lower part of the uterus is harder, lar- 
ger, and more tender than natural.''^ 

The bearing down sensation, frequently the prin- 
cipal symptom complained of, will be more or less, 
according to the misplacement. 

Treatment. — This will consist in improving the 
general health of the patient, and removing the in- 
flamed, congested condition of the womb ; for this 
purpose, the treatment recommended under that 
head, will be indicated, to a great extent, in this. 
The local application of tannin, alum, sulphate of 
zinc, or sulphate of iron ; also, the nitrate of silver 
solution, will be sufficient for the simpler forms of 
ulceration, but as the disease becomes more aggra- 
vated, the sohd nitrate of silver, or caustic pot- 
ash, also the acid nitrate of mercury, or a strong so- 
lution of iodine, care being taken to protect the 
mucous membrane of the passage from the action of 
these violent caustics. If there is much misplace- 
ment of the womb, this must be corrected. A tepid 

* Rigby on Female Diseases, page 106. 



THIRTY YEARS OF FEMALE LIFE. 89 

hip or sitz bath, every day, or every other day, and 
injections up the front passage, of warm water, are 
necessary to the cure, as well as comfort, of the pa- 
tient ; washing out the vagina occasionally, with a 
tea, made of chamomile flowers or marsh-mallows, 
will be found soothing and grateful, also an injection 
up the vagina or rectum, of poppy-head tea, will be 
of service in relieving the pain. The bowels 
should be kept in a soluble condition by mild ca- 
thartic medicines. 



CHAPTER XIII. 

CANCER OF THE WOMB. 

Medical writers consider this disease according 
to the various aspects it assumes. Yet, for all prac- 
tical purposes, it may be regarded as an ulceration 
of the mouth or neck of the womb, or both, more 
or less rapid in growth, destructive to the parts 
affected, and fatal in its termination. Depending, in 
the first place, upon inflammation, and modified in 
its action by peculiarities either general or local, 
as for instance, a scrofulous condition of the womb; 
should this organ, in this state, be attacked with 
cancer, it would naturally assume a form not ob- 
served in another case, where this peculiarity did 
not exist. Also, the intensity of the inflammation, 
the particular tissues implicated, the amount of en- 
gorgement or congestion of the womb, previous to 



90 THIRTY YEARS OF FEMALE LIFE. 

the canerous affection becoming manifest, would all 
exert a modifying influence. In regard to the 
causes of cancer of the womb, little is known posi- 
tively ; the reason of this is, physicians are not gen- 
erally consulted until the disease has made more 
or less progress ; they are, therefore unacquainted 
with the previous condition of the uterine organs. 
Among the causes, are enumerated injuries to the 
womb by instruments, to produce abortion, and 
expedite difficult parturition ; frequent child-births ; 
yet it is said to occur more frequently in females 
who have never conceived ; this would seem to imply 
some previous uterine or ovarian disorder, Avhich, 
no doubt, is the case ; and were it possible, in all 
cases of cancer of the womb, to trace the previous 
history of the female back to the first appearance 
of menstruation, we should find, that at some period 
of her life, between the age of puberty and the de- 
velopment of cancer uteri, she had suffered, to a 
greater or less extent, from abnormal menstruation. 
In this vicAv, we leave out those cases of cancer that 
can be traced to some other known cause. But in 
the absence of further information, what more pro- 
lific cause could there be, than faulty menstruation. 
Child-birth is a natural process ; it is the destiny of 
women to increase and replenish the earth, and 
does not necessarily entail disease upon her who 
who fulfils this mandate of the Creator ; we ought, 
therefore, to expect this result, only in such cases 
where the reproductive process was performed un- 
der adverse circumstances. The menstrual function 



THIRTY YEARS OF FEMALE LIFE. 91 

is also a natural peculiarity of the sex ; appearing 
and disappearing, month aftermonth, and year after 
year, causing no disturbance of the system when not 
perverted by abnormal action. But we have shown 
that the female reproductive organs, are extremely 
liable to disease at any period of menstrual life ; 
that this liability is greatly enchanced at puberty, 
very often from mismanagement or improper treat- 
ment, resulting in acute or chronic ovarian or uter- 
ine inflammation ; this, in it3 turn, resulting in con- 
gestion or engorgement of the w^omb ; and we have 
seen this condition remain for any length of time, 
producing more or less derangement of the men- 
strual function. Again, it is stated, that cancer of 
the womb is more apt to make its appearance about 
the time for the cessation of menstruation, than at 
any other. Why should this period conduce to its 
development more than any other, if the mode in 
which the menstrual function has been previously 
performed, has nothing to do Avith the development 
of this disease ? 

Hereditary transmission is recognized by medical 
writers, as a cause of cancer. This implies a pecu- 
liar principle in the circulating fluids, which, under 
certain influences, attacks the womb or breasts, and 
assumes the malignant form of cancer. Between 
these organs, there is a strong sympathetic action, 
manifested by the influence exerted on them by 
pregnancy. Some women know that they have 
conceived, a few days after it has occurred, by the 
sensations exDerienced in their breasts, aside from 



92 THIRTY YEARS OP FEMALE LIFE. 

any other symptoms they may have. And in cases 
of obstructed menstruation, the show has made its 
appearance, in consequence of applying warm 
poultices to the breasts ; also in tumors of the 
womb, the breasts have been known to enlarge, and 
result in the secretion of milk, as in true pregancy. 
That cancer should attack the uterus and breasts, 
in preference to any other parts of the female or- 
ganism, is just what might be expected, if we con- 
sider the fact, that during the thirty years of men- 
strual life, the womb is called into action by a peri- 
odical afflux of blood into its tissues, and the 
breasts become altered in texture by pregnancy, 
lactation and various uterine diseases. A woman 
dies of cancer ; her daughter, on arriving at the 
turn of life, or previously to this critical period, is 
also a victim to the same disease. Now, this does 
not prove that cancer, as a special disease, is here- 
ditary, for such cases do not occur often enough to 
substantiate the assertion ; it is a mere coincidence, 
as though a person has a fall, and breaks a limb; the 
daughter, at some time of her life, the latter part, 
it may be, meets with the same calamity ; now, no 
one would argue that the breaking of the limb was 
a hereditary peculiarity. 

But is there no such thing as hereditary disease ? 
Certainly there is, and it plays an important part 
in the mortality reports of all ages, and both sexes. 
"We see sickly children, who have inherited a weak- 
ly constitution from their parents, probably the on- 
ly legacy they were able to bequeath to them ; but 



THIRTY YEARS OF FEMALE LIFE. 93 

it may not be in the form of scrofula, consumption, 
or cancer, yet it is a feebleness of the vital forces 
that may be developed into either of these com- 
plaints. It is said that some constitutions are more 
predisposed to cancer than others ; granted, and the 
same may be said of other diseases. Three persons, 
for instance, are exposed to the same influence, 
cold ; one will have inflammation of the lungs, an- 
other rheumatism, and the third, bilious fever ; 
these several diseases, induced by the same cause, 
and each assuming its particular form, in conse- 
quence of some previous condition of the system, is an 
every day occurrence. As a further illustration, 
take the consumptive, with his ulcerated lungs ; 
there was a time when he was little suspected of 
being a victim to this disease ; his constitution, 
however, never of the strongest, w^ith more or less 
weakness of the breathing apparatus, the lungs per- 
forming their office with labor and difficulty ; he 
takes a cold, it settles upon the lungs, and they, not 
possessing sufficient vital action to repel the enemy, 
yield an easy prey to its devasting influence. 
Again, a female child inherits a feeble or scrofulous 
habit, her mother may have had a cancer or not. 
She comes to puberty as well prepared, physically, 
it may be, for the great change that is about to be 
ushered in, as girls in general ; menstruation is 
finally established, without any great disturbance of 
the system ; but, from some of the causes which 
have been previously mentioned, the flow has been 
obstructed, congestion of the tissues of the womb 



94 THIRTY YEARS OF FEMALE LIFE. 

follows, to a greater or less extent ; after a time, the 
monthly discharge is re-established, and she goes 
through the pains and penalties of child-birth, sev- 
eral times, it may be, during the reproductive sea- 
son ; suffering, in the mean time, more or less from 
menstrual derangement, leucorrhoea, or misplace- 
ment of the womb. At last, the second critical pe- 
riod arrives, and from symptoms Avhich now mani- 
fest themselves, she is found to be afflicted with 
cancer. Now, who will say that the first menstrual 
difficulty may not be the exciting, and the scrofu- 
lous habit the predisposing cause of her future 
sufferings ? 

"We know that chronic inflammation may attack 
any of the mucous or serous tissues of the body, 
and remain, as such, for years or for life ; that it may 
assume a chronic form, independent of an acute at- 
tack, aggravated from time to time, as in rheumatic 
and bronchial affections, from a sudden atmospheric 
change, or exposure to cold and wet. In regard to 
the first uterine affection, we have no knowledge 
tha^ it was ever entirely removed ; it is, therefore, 
more than probable that the alteration of the tissues 
of the womb, a necessary consequence of congestion, 
has rendered this organ more obnoxious to the de- 
velopment of malignant disease, than it would have 
been, had this condition never existed. 

The cause of cancer is of more importance than 
the treatment, for Avhen the uterus is in that condi- 
tion, recognized as cancerous, it is rarely cured. 
That certain indurated and ulcerated conditions of 



THIRTY YEARS OF FEMALE LIFE. 95 

the organ, simulating this disease in some respects 
have been cured, is readily admitted ; and further, 
that all such abnormal conditions of the womb may- 
be brought to a favorable issue, under judicious 
treatment, if taken in season. But that confirmed 
cancer has met with such a favorable termination, 
is more than doubtful. 

" Cancer may develope itself at any period of 
life ; but it is very rare for that of the uterus to 
make its appearance earlier than at twenty-five 
years ; nevertheless, we have observed, and writers 
have reported, several examples of uterine cancer, 
even before tAventy years of age. From the statis- 
tical researches we have been enabled to make in 
hospitals, from our particular practice, and especial- 
ly from the works published on this subject, we 
have found, by following the order of frequency, 
that this frightful malady appears most commonly 
at the age of from forty to forty-five years, then 
from thirty to forty, from forty-five to fifty, from 
twenty-five to thirty, from fifteen to twenty, 
from fifty to sixty, and finally from sixty to seventy. 
It may be seen, from this table, that cancerous af- 
fections of the uterus are the more frequent, in pro- 
portion as that organ is in a greater state of activi- 
ty, and when it begins to pass into the physiologi- 
cal inertia of the critical age.""^ 

Symptoms. — At first, the symptoms may be so 
slight, that the disease has made considerable pro- 
gress before any suspicion is excited, particularly 

*Colombat on Females, page 336. 



96 THIRTY YEARS OF FEMALE LIFE. 

if the patient has suffered from any previous uterine 
ailment ; as, in that case, she would be apt to consi- 
der them as nothing more than an old complaint, 
which had previously afflicted her ; the hemorrhage, 
also, which often occurs in cancer, might be mista- 
ken or considered the change of life, which was 
working upon her, if it occurred at the age when 
she was expecting this change. In fact, the symp- 
toms of cancer do not differ from many other uter- 
ine diseases, as much as would naturally be expect- 
ed ; the pain and discharge, and even these are not 
observed in many cases ; pain, at some stage of the 
disease is probably the most usual symptom, and 
" when present, it is generally constant, but aggra- 
vated by very severe paroxysms, which, commencing 
in the region of the uterus, shoot through the pelvis 
and loins, and down to the anus and thighs. So 
limited, and yet severe, is this about the rectum, 
and lower part of the spine, that I have had pa- 
tients in advanced stages of cancer, who came to 
consult me, for what they assured me, was only bad 
piles. In some cases, the warmth of the bed ap- 
pears to increase the suffel-ing.'^"^ 

As the disease advances, the pain usually in- 
creases in severity. It is sometimes described as a 
burning, stabbing pain, as though knives Avere 
plunged into the body. There is more or less de- 
rangement of the menstrual function, sometimes 
greatly increased, appearing in gushes, or a constant 
flow, also frequent suppressions. 

* Churchill's Diseases of Wom^n, page 252. 



THIRTY YEARS OF FEMALE LIFE. 97 

*^ Some women experience a sort of voluptuous 
pruritus in the genital parts, especially at tlie vulva, 
which inclines them to coitus and illicit mancDeuvres; 
the conjugal act generally, but not always, causes 
more or less acute pain ; to these symptoms are ad- 
ded acute and transient pains in different parts of 
the body, especially in the breasts, which become 
firmer and larger ; attacks of hysteria, unusual mel- 
ancholly, extreme disgust for food, strange longings, 
and finally a general uneasiness, which cannot be 
accounted for, until all doubts are removed as to 
the existence of the disease.'^* 

When the disease comes on after menstruation 
has ceased, the woman sometimes imagines that this 
function has returned, and experiences little appre- 
hension until a serious hemorrhage takes place, 
which induces her to seek advice. Another pretty 
general symptom of cancer uteri, is a more or less 
constant discharge, of very disagreeable odor, un- 
like any other in quality or offensiveness, to which 
the generative organs are liable. 

'* The color of the discharge varies from a dirty 
white to a dark brown, green or black ; now and 
then it receives a tinge of color from the admixture 
of a small quantity of blood. ^^t 

An examination causes considerable pain, and the 
neck of the womb is found to be tender, and bleeds 
at the touch ; the mouth of the womb is more open 
than natural, and the edges considerably thickened ; 
the whole body of the organ becomes enlarged 

*Coloinbat on Females, page 337. fib. page 253. 



98 THIRTY YEARS OF FEMALE LIFE. 

and immovable, from increase of size, and from 
the attachments it forms with the surrounding 
viscera. 

^' The stomach soon sympathizes with the organic 
distress. The appetite gradually diminishes, and 
ultimately almost ceases ; digestion is performed 
very imperfectly ; the patient complains of nausea, 
with occasional vomiting, and sometimes of a burn- 
ing heat in the region of the stomach, extending to 
the intestines. There is intense thirst. Diarrhoea 
alternates with constipation, and it is difficult to say 
which occasions the most distress.''* 

The discharge is sometimes so acrid, that it ex- 
coriates the external parts, and inside of the thighs, 
adding greatly to the distress of the patient. The 
sleep is disturbed and unrefreshing, an anxious, dis- 
tressed look about the countenance, indicative of 
great suffering, emaciation and swelling of the 
extremities, profuse hemorrhages, despair and 
death. 

Treatment. — As to the treatment of confirmed 
cancer, little more can be done than simply make 
the patient as comfortable as may be, while labor- 
ing under this frightful malady. Local remedies 
are resorted to in all stages of the disease, to check 
the hemorrhage, retard the ulceration, and cleanse 
the parts. To fulfil the first indication, the different 
caustics are resorted to, nitrate of silver, acid nitrate 
of mercury, caustic potassa, arsenical paste, chlor- 
ide of zinc, and others; the first and last named 

♦ Churchill on Diseases of Women, page 255. 



THIRTY YEARS OF FEMALE LIFE. 99 

preparations will be found as useful as any. Re- 
moving the diseased portion of the womb, by the 
knife, has been done many times, but the univers- 
ally fatal results, makes the operation very unpop- 
ular, particularly in this country. The whole uterus 
has been r.emoved for the cure of this disease, but 
the operation has resulted in death, as might have 
been anticipated. From the results observed in 
the application of the hot iron to cancer uteri, it 
would seem to be worthy of much more extended 
practice. The patients, however, experience a 
dread of this remedy, yet the pain resulting from it 
is much less than that caused by some of the caus- 
tic preparations. 

In some cases of violent hemorrhage, where the 
life of the patient is in danger, plugging the 
vagina, as recommended in uterine hemorrhage, 
has been resorted to ; and internally for this pur- 
pose, ergot in powder or tincture, also injections up 
the vagina of solutions of nitrate of silver, alum, 
sulphate of zinc and other astringents, will be of 
more or less advantage ; great relief will be deriv- 
ed by injecting up the vagina flaxseed tea, about 
four ounces, and tincture of conium two tea-spoons- 
ful, or a tea-spoonful of laudanum instead of the 
conium, and other remedies of this class. To re- 
move the disagreeable odor, the vagina should be 
washed out occasionalUy with a solution of chloride of 
soda or of lime ; cleanliness is of great importance 
in this disease, it adds much to the comfort of the 
patient ; for this purpose, simple water is used. 



100 THIRTY YEARS OF FEMALE LIFE. 

Even in health, there is as much necessity for a 
woman to wash out the vagina every day, as to wash 
any other part of the body; and were it more generally 
practiced, it would assist very much in keeping the 
passage free from that weakness so common to the 
sex. The internal treatment is of the greatest im- 
portance, whether considered as alterative, in the 
early stage, or palliative, in the more advanced stage. 
In regard to the former, the earlier they are resor- 
ted to, the greater will be the benefit derived from 
them. To this end, the following preparation will 
often have a good effect, iodide potassa thirty grains, 
fluid extract of sarsaparilla four ounces, fluid ex- 
tract of yellow dock four ounces ; Dose^ one tea- 
spoonful three times a day, which may be increas- 
ed to twice this quantity, also LugalFs solution of 
iodine, citrate of iron, and other preparations of this 
class. Fowler^s solution of arsenic, in eight or ten 
drop doses, gradually increased to the full dose, 
and iodide of arsenic one twentieth to one fifteenth 
of a grain, twice a day, have been highly recommen- 
ded, as the disease becomes fully established ; at 
this time, also, the different narcotic preparations 
are required, as camphor and henbane three to six 
grains at night, also opium, laudanum, morphine 
or black drop. Conium has had a favorable repu- 
tation in this disease. 

The pain in the lower part of the back is often 
greatly relieved by injections up the rectum, of flax- 
seed or marsh-mallow tea, with laudanum, or watery 
extract of opium ; also by a decoction of poppy 



THIRTY YEARS OF FEMALE LIFE. 101 

heads. A blister to the sacrum, sometimes does 
good, particularly if, to the blistered surface, mor- 
phine is applied ; it greatly mitigates the pain. 
The bowels should be kept open with saline purga- 
tives, as they are less irritating than many others of 
this class. Animal food should be used in moderate 
quantities, and other articles of diet that are nutri- 
tious and easy of digestion. Some cases may re- 
quire general or local bleeding, but they are rarely 
met with. The disease called coroding ulcer of the 
womb, differs so little from the one just described, 
if not indeed the same in one of its forms, calls for 
no special description, as both may be induced by 
the same cause, and characterized by the same 
symptoms, to a greater or less extent ; they both 
eat and destroy the parts attacked, and both result 
in death. The treatment applicable to one, applies 
equally to the other. 

The woman should bear in mind, that a disease of 
the womb, capable of producing simple ulceration, 
may, in a weakly or scrofulous constitution, degene- 
rate, by neglect of proper treatment, into the malig- 
nant disease previously mentioned. The import- 
ance, therefore, of attending to the first symptoms 
of abnormal action of the reproductive organs, 
must be apparent to all. The majestic oak, tower- 
ing in its might above the trees of the forest, grew 
from a little acorn. Thus it is with many serious 
diseases, to which the human organism is liable, 
springing from small beginnings ; some little gland 
or organ, considered of minor importance, so far as 



102 THIRTY YEARS OF FEMALE LIFE. 

it may be individually concerned, takes on a diseased 
action, the surrounding parts become implicated, 
and by neglect, continues to spread, until some vital 
part is reached, and death is the result. Bear in 
mind, then, that every part of the human body is a 
part of the complete whole. That like a complica- 
ted and wisely constructed machine, there must be 
harmonious action in all its parts, to ensure happi- 
ness and health. 



CHAPTER XIV. 

MISPLACEMENTS OF THE WOMB. 

By referring to what has previously been said, in 
regard to the position of the womb, we shall find 
that it is suspended in the pelvis, between the blad- 
der and rectum, and resting on the upper part of 
the vagina ; the ligaments attached on each side, 
assist in maintaining it in the upright position. 
From this short sketch of its anatomical position, 
and relation to surrounding parts, it is evident that 
the womb must necessarily be liable to various de- 
viations from its natural position. And from the 
important nervous connections, a misplacement of 
the organ would cause more or less suffering, and 
dijfficulty in evacuating the rectum and bladder. 
Among females, this disease is well known, and by 



THIRTY YEARS OF FEMALE LIFE. 103 

them is called falling of the womb ; it is a very 
common complaint; young or old, married or single, 
being alike subject to it. Yet it is more frequently 
met with in married women, and in those who have 
had several children, more frequently than any 
others. 

There are several ways in which the womb may 
be misplaced, as follows : — it may be turned, so 
that the top part of the womb will press upon the 
rectum, and the mouth of the womb against the 
bladder; or the mouth may be in its natural position, 
but the top presses on the rectum, as in the previ- 
ous case ; when it is in this condition, it is more or 
less curved or bent, and the passage through the 
neck of the womb, becomes, in some cases, partial- 
ly closed. There is another condition, the opposite 
of 'what has just been described, namely : — the top 
part of the womb presses on the bladder, and the 
mouth of the womb against the rectum ; or the 
mouth may be in its natural position, and the top 
part still press on the bladder. The upper part of 
the w^omb may, from weakness of the ligaments, and 
other causes, press upon the inside of the pelvis, op- 
posite the hip, on either side ; when this is the 
case, the nerves and blood-vessels supplying the 
lower extremities, are compressed, producing numb- 
ness and pain. The womb may, from weakness of 
the walls of the vagina, and relaxation of the liga- 
ments, come suddenly down to the external parts, 
or it may gradually settle down, until it protrude 
entirely through the external parts, and hang there, 



104 THIRTY YEARS OF FEMALE LIFE. • 

like a tumor, between the thighs, until replaced ; the 
womb may also be inverted, that is, turned inside 
out, as you would turn the finger of a glove, and in 
this condition, come out of the passage. 

A very peculiar feature of the several misplace- 
ments, is the excessive pain, and other disturbances, 
complained of by some women, when the deviation 
from a natural position is but slight ; other cases, 
again, are the opposite of this ; great misplacements, 
causing little or no inconvenience. Suspended 
within the pelvis by supports that are liable to be- 
come weakened from various causes, we should not 
be surprised to find the womb often misplaced, par- 
ticularly if we consider that " the risk of its dis- 
placement is further increased by the circumstance 
that its weight and size are subject to variations^ 
and that the very causes which render it heavier 
and larger than natural, have the further effect of 
diminishing the power of those supports, by which 
it is retained in its natural position."^ 

Being, from its position, constantly pressed upon 
by the intestines from above downwards, and this 
pressure greatly increased by the different move- 
ments of the body, as in lifting, jumping, coughing 
and straining at stool, should the vagina become 
weakened from leucorrhoea, or the ligaments become 
relaxed, as in frequent child-births, the womb will fall 
as certainly as any other substance without the bo- 
dy, if the support on which it rests is removed. 

♦ West on the Diseases of Wo men ^ page 123. 



THIETY YEARS OF FEMALE LIFE. 105 




Falling of the Womb, — C, the Womb. 



Falling of the womb is a rare complaint before 
puberty, but after menstruation has been established, 
the liability is greatly increased, particularly if 
there is leucorrhoea or derangement of the menstru- 
al function ; as the former produces relaxation of 
the vagina, and the latter has a tendency to increase 
the weight of the womb. When the vagina is in a 
healthy condition, its walls are in close contact, 
and possess a power of resistance, which is not the 
case usually, if leucorrhoea is present. It is, there 
fore, more a weakness of the vaginal walls, that in- 
duces or predisposes to falling of the womb, than 
relaxation of the ligaments. If there is leucorrhoea, 
obstructed or painful menstruation, the womb is 
probably more or less affected with chronic inflam- 
mation, or engorgement ; in either case, it being 
larger and heavier than natural, it is more prone, 
than in a healthy condition, to prolapse. 



106 THIRTY YEARS OP FEMALE LIFE. 

Pregnancy and child-birth, act as a predisposing 
cause of falling of the womb, by increasing the 
weight of that organ, but more particularly, by the 
great distention of the parts, necessarily resulting 
from labor ; and by getting up too soon after child- 
birth at full term, or abortion at any period, 
the woman is very liable to this complaint. Too 
violent exercise, during menstruation, sometimes 
results in falling of the womb ; while the show is 
present, the parts connected with the uterus are 
more or less open and relaxed than at another time ; 
hence it is, that a fright, or fall, jumping, riding on 
horseback, or violent coughing at this particular 
time, has been known to produce this difficulty. 

Symptoms. — If the misplacement comes on sud- 
denly, as from a fall, or lifting a heavy weight, the 
pain is usually very severe about the lower part of 
the back, extending through to the groins and 
lower part of the bowels. When it is more gradual 
in its occurrence, the pain is more or less constant, 
particularly when the woman is on her feet, of a 
dull, dragging kind, with a fullness of the pelvis, 
and pressure on the bladder and rectum. Some 
women are obliged to press the womb up with their 
finger before passing water. When lieing down, 
the womb frequently goes up of itself ; hence it is, 
that a person afflicted with this complaint, feels less 
inconvenience from it when in the recumbent pos- 
ture, but as soon as they get up on their feet again, 
it returns. In some cases, where it is only a little 
lower than natural, the distress is greater than in 



THIRTY YEARS OF FEMALE LIFE. 107 

others, where the whole organ is entirely without 
the body ; pain, as a symptom, therefore, cannot be 
relied upon, as it may be very severe, or but slight. 
The bearing down sensation is complained of in 
most cases. Leucorrhoea is often present, and as 
before stated, is the cause of the falling many times. 
The stomach sympathizes with the misplaced womb, 
as in all other uterine complaints, resulting in more 
or less derangement of the general health. 

Treatment. — Bleeding from the arm, and leeches 
applied to the neck of the womb, may be necessary 
in some cases, where there is considerable inflam- 
mation, and congestion of the womb, which is often 
the case in this complaint ; also astringent injec- 
tions up the vagina, to restore its tone, and check 
the leucorrhoea, such as the following, nitrate of 
silver, twenty to forty grains, to half a pint of wa- 
ter ; decoction of oak bark and alum ; sulphate of 
copper, or sulphate of zinc two drachms, water 
one pint, and other astringent preparations, as re- 
commended for leucorrhoea. Rest in the recumbent 
posture will be of great benefit ; half a pint of cold 
water injected up the rectum two or three times a 
day, will do good in many cases. Tonics will be 
required, to improve the general health, and some 
of the preparations of iron will be of great service 
in this complaint. 

If the falling of the womb occurs in elderly 
women, and also in other cases, if the uterus has 
come entirely out of the body, after being replaced, 
some support may be necessary to keep it within 



108 THIRTY YEARS OF FEMALE LIFE. 

the body ; for this purpose, a bandage from front 
to back, passing between the thighs, with a pad cov- 
ered with oiled silk, about two inches wide, and three 
or four inches long, placed so as to press up against 
the front passage, will keep the womb in the vagina ; 
this bandage should be attached in front, and on 
the back, to one passing round the hips ; instead of 
the pad, a roll of fine cambric or linen, about four 
inches long, wet w4th alum water, or some other 
astringent, may be introduced up the vagina, and 
secured there by the bandage ; this makes a very 
convenient pessary, and one that the woman can 
make and use herself ; but it should be removed 
every day, cleansed, and introduced again ; in many 
cases, she need not use it except Avhen on her feet 
about the house. 

Pessaries of various kinds are used, but the prin 
ciple on which they act is the same in all ; what- 
ever will keep the womb in its place, with the least 
trouble and inconvenience, is the best. Some use 
a piece of sponge for this purpose, but it often 
causes so much irritation, that it is soon laid aside ; 
if u:ed, it should be often removed and cleansed. 
The bowels should be kept regular with saline ap- 
p orients. 

The perineum is sometimes ruptured in child- 
birth ; in such a case, the space between the front 
and back passage is more or less lacerated ; it may 
be partial, or entirely ruptured ; in the latter case, 
both passages are torn so as to form one outlet. 
With this condition of the parts, a falling of the 



THIRTY YEARS OP FEMALE LIFE. 109 

womb is rarely cured without a surgical operation, 
by bringing the torn surfaces together, after having 
first made them raw, and keeping them thus until 
they unite, which is not always followed with this 
favorable result. 

Some remarkable cases of falling of the womb are 
recorded, where the organ having been forced 
through the external parts "until it hung like a 
tumor between the thighs, in which condition the 
female has gone about her work as though nothing 
was the matter ; also of its having been entirely re- 
moved by the ligature and knife, with a perfect re- 
covery of the patient ; but such cases are extremely 
rare. 




Ajxteflbxjou or the "Wosib.— C, the Womb, the upper part pressing on 
the Bladder. 

Anteflexion and anteversion of the womb is a mis- 
placement of the organ, to which females are liable 



110 THIRTY YEARS OF FEMALE LIFE. 

at any time. It may occur before puberty, but is 
more frequently met with after child-birth and abor- 
tion. In anteflexion, the womb is tilted over, and 
presses on the bladder ; the mouth of the womb is 
in the natural position, or nearly so. In anteversion, 
the upper part of the womb presses on the bladder, 
as in anteflexion, but differs from that in respect to 
the position of the mouth of the organ, which is 
pressing on the rectum. The womb is, therefore, 
crosswise in the pelvis, and must give rise to more 




Antetersion op the Womb. — C, tlie "Womb, turned crosswise in the Pelvis, th« 

upper part pressing on the Bladder, and the mouth of the "Womb pressing 

on the Rectum. 

or less inconvenience, which is usually the case. 
The pressure on the rectum, in some cases, produces 
pain in that region, and costiveness. There is pain 
in the lower part of the bowels and loins, with a 
frequent desire to pass water, from the pressure of 



THIRTY YEARS OF FEMALE LIFE. Ill 

the upper part of the womb on the bladder, which 
ia frequently in an irritable condition from this 
cause. The monthly periods are not usually much 
affected ; one peculiarity, however, is mentioned by 
some women, that when on their feet, the flow is 
much less than when lieing down ; in regard to the 
anteflexion, the monthly periods may be partially ob- 
structed, in consequence of the bent or curved con- 
dition of the neck of the womb. 

Causes. — Anything that increases the weight of 
the upper part of the womb, as chronic engorge- 
ment or congestion, the result, in some cases, of a 
cold, taken at a menstrual period. Pregnancy has 
this effect, but if it happens from this cause, it is 
usually before the third month. Immediately after 
cliild-birth or abortion, the womb is in a favorable 
condition for this misplacement, the ligaments are 
more or less relaxed, consequently it yields more 
readily to the pressure of the bowels from above, 
and is pressed over, either front or back. It may 
also be caused by a tumor, a fall, or over dis- 
tension of the bowels, from costiveness. 

Treatment. — The cause producing the misplace- 
ment must be removed before it can be cured ; 
when this is accomplished, the womb usually re- 
sumes its natural position, unless it has formed at- 
tachments in consequence of peritoneal inflamma- 
tion. If it has come on immediately after child- 
birth, the bowels should be freely evacuated, and 
the woman confined to her bed for a number of 
days, and lie on her back as much as possible ; the 



112 THIRTY YEARS OF FEMALB LIFE. 

womb will thus, from its own weight, have a ten- 
dency to seek its natural position. 

Retroflexion and Retroversion. — This is an op- 
posite misplacement from that just described, and 
more frequently met with. In retroflexion, the up- 
per part of the womb is turned over into the hollow 
of the sacrum, and presses on the rectum ; the 




Kktrofleuon of thk Womb. — C, the "Womb, tne upper part pressing on the 
Reetum. 

mouth of the womb is in the natural place. In re- 
troversion, the mouth of the womb presses on the 
bladder, or some portion of the water passage, and 
the upper portion of the womb is in the hollow of 
the sacrum, as in retroflexion. By referring to 
what has been previously stated, in regard to the 
position of the internal organs of generation, we 
shall find that the womb is situated between the 
bladder and rectum, that it is suspended in this po- 



THIRTY YEARS OF FEMALE LIFE. 113 

sition by the ligaments on each side, and rests on 
the upper part of the vagina ; to maintain this posi- 
tion, there must be a normal condition in all the 
parts ; if there is a weakness of the walls of the 
vagina, the womb falls too low down in the passage, 
and if the ligaments are relaxed, it may tip over, 
front or back, or it may incline to the right side or 
the left, from the same cause. To produce either 
form of the misplacement, there is only necessary 
a sufficient force to overcome the action of the sever- 
al parts, which assist in maintaining the womb in its 




RETROVEESioy OF THE WoMB. — C, the Womb, turned crosswise in the Pelvis, the 

upper part pressing on the Rectum, and the mouth of the Womb pressing on 

the Bladder. 

proper position. Eetroflexion and retroversion of 
the womb, may be produced by the same causes 
that were mentioned in regard to anteflexion and 
anteversion, to which may be added, an over disten- 
sion of the bladder, from an accumulation of urine. 



114 THIRTY YEARS OP FEMALE LIFE. 

Many females bring on this misplacement by going 
too long without passing water, and when, at last, 
they attempt to do so, they find, to their great 
surprise, that they are unable to relieve themselves; 
the bladder has become so full, that it has pushed 
over the womb ; in other words, it is retroverted ; 
the neck of the womb presses against some portion 
of the bladder, or it may press against the neck of 
the bladder, and prevent the urine from escaping ; 
and if the difficulty is not removed in time, the 
bladder becomes so full, that it bursts, and death is 
the result. There are a number of such cases on 
record, or, as more frequently happens, there is a 
gradual dribbling of the water, to the great incon- 
venience of the patient. Violent exercise during 
menstruation, is sometimes a cause of this misplace- 
ment. When the show comes on, the womb being- 
heavier than at other times, is more easily thrown 
out of place, by jumping, dancing and riding on 
horseback. Also, by being confined to the bed from 
sickness, the womb has a tendency to fall over into 
the hollow of the sacrum from its own weight, the 
parts being relaxed, and the woman lieing on her 
back ; from the same cause, it may fall to the right 
or left side, or press upon the ovaries. A misplace- 
ment of the womb has occurred in young girls, from 
jumping the rope until they were greatly fatigued ; 
a healthy exercise enough, if participated in with 
moderation, but injurious, if carried to excess. Al- 
though it may occur in females who have never 
been pregnant, yet women who have had a number 



THIRTY YEARS OF FEMALE LIFE. 115 

of children are more liable to it. Acute or chronic 
inflammation, and congestion or engorgement of the 
body of the womb, is often the cause of this mis- 
placement. It may also occur during the first three 
or four months of pregnancy. 

Symptoms. — If the retroversion or retroflexion oc- 
cur suddenly, the patient usually complains of severe 
pain in the lower part of the back, extending 
through the pelvis to the groins, and inside of the 
thighs, and when it comes on gradually, there is 
more or less constant pain, and the bowels are gen- 
erally constipated, from the pressure of the body of 
the womb on the rectum, and if the womb is in an 
inflamed condition, a movement of the bowels 
causes great pain : there is more or less pain and 
difficulty in passing water, or it may be entirely 
suppressed, from the mouth of the womb pressing 
on the neck of the bladder ; a dragging sensation 
in the loins, pain in the ovarian region, extending 
down the thigh, with numbness, from the pressure 
of the womb on the ovary, nerves, and blood- 
vessels supplying the thigh and leg ; a feeling 
of weight in the pelvis, and bearing down ; 
pressure on the back passage, with a frequent 
inclination to go to stool. The monthly peri- 
ods are sometimes affected ; there may be a pain- 
ful or obstructed menstruation, from the b ending- 
over of the womb, and partial closure of the pas- 
sage through its neck. If the misplacement occur 
during menstruation, the show may be arrested, 
causing great distress. 



116 THIRTY YEARS OF FEMALE LIFE. 

" Retroversion of the uterus may terminate fatal- 
ly> by one of three modes ; either by irritation, by 
inflammation, or by sloughing of the bladder. In 
the first instance of this kind which I ever saw, 
death was produced by inflammation. The patient 
was in the fourth month of pregnancy. She had 
been suff*ering from retention both of urine and feces, 
nine days, and her abdomen was immensely dis- 
tended. The village apothecary had been giving her 
nitrous ether as a diuretic. I introduced the 
catheter, by keeping the point close against the 
pubes, and drew off several quarts of urine, with 
which were mixed puriform and bloody streaks. 
She suffered great pain in the region of the bladder, 
accompanied with the usual symptoms attendant on 
inflammation ; but in spite of bleeding and purga- 
tives, she died. On examination, the uterus was 
found to participate in the inflammation of the 
bladder; it was still retroverted, though labor- 
pains came on, and she miscarried, soon after the 
urine was drawn off. It is generally believed that 
the uterus will regain its proper place, when re- 
lieved of its contents ; in this case it was otherwise, 
the fundus being found, after death, below the pro 
montory of the sacrum. ^'"^ 

Some women experience much less inconvenience 
than others from retroversion and retroflexion ; this 
peculiar difference is owing either to the gradual 
manner in which the misplacement has occurred, or 
the want of that sympathetic action, between one part 

* Gooch's Midwifery, page 118. 



THIRTY YEARS OP FEMALE LIFE. 117 

of the system and another, usually observed. There 
are very few cases, however, but what feel more or 
less weight and pressure about the rectum, and 
other symptoms previously mentioned, together 
with derangement of their general health, leucor- 
rhoea, and difficulty in walking. 

Treatment. — If there is retention of urine, it 
must be removed by introducing an instrument into 
the bladder, called a catheter, through which the 
water escapes ; this is a simple operation when the 
internal organs are in their natural position, but a 
very difficult one in some cases of retroversion, from 
the pressure of the womb against the water pas- 
sage ; usually, however, by working cautiously, the 
catheter, either a round or flat one, can be introdu- 
ced, and the urine drawn off; then by introducing 
the finger into the vagina, and pressing down the 
neck of the womb, carrying it backward and upward, 
the womb will occupy its due position ; it may be 
necessary, in some cases, to press up the body of 
the womb, with a finger of the other hand intro- 
duced into the rectum at the same time. It often 
happens that there is little or no retention of urine, 
and by pushing up the body of the womb until it 
can pass the promontory of the sacrum, it shoots up 
into its position like a dislocated limb into its socket. 
In some rare cases of this misplacement, occurring 
during the early months of pregnancy, before the 
womb can be righted, it has been necessary to bring 
on a miscarriage, by introducing an instrument into 
the womb through the os uteri, and when this could 



118 THIRTY YEARS OF FEMALE LIFE. 

not be reached, to thrust a sharp pointed instrn- 
ment into the lower portion of the organ, and let 
out the water ; the womb then contracting, is more 
readily replaced, and abortion follows. When the 
womb is misplaced from pregnancy, it is usually 
before the fourth month, and unless the symptoms 
are very urgent, it had better be left to nature, as 
the gradual enlargement of the womb will soon cor- 
rect the difficulty. 

Retroflexion is more frequently met with than re- 
troversion, and the distress arising from the pressure 
on the rectum, is often attributed to piles, which 
are often caused by it, and frequently exist with it. 
By referring to the natural position of the womb, 
suspended as it is within the pelvis, between the 
bladder and rectum, it would seem, at first sight, a 
very simple matter to cure any misplacement which 
might happen to it ; yet experience teaches differ- 
ently. It may be easy enough to introduce the 
uterine sound, in some cases, and place the womb 
where it should be ; but it often happens that as 
soon as the instrument is removed, the organ re- 
turns to the unnatural position again, and nothing is 
gained ; it is also a difficult matter to introduce the 
instrument into the womb, from the curved condi- 
tion it is in, and when it is accomplished, the posi- 
tion of the womb being reversed, the instrument 
must be reversed, in order to enter the cavity of 
the organ. It is, therefore, to be introduced with 
the concavity down, and the handle of the instru- 
ment nearer the rectum than would be necessary, 



THIRTY YEARS OF FEMALE LIFE. 119 

if the womb was in the proper position to introduce 
the sound. 

In cases of anteflexion and anteversion, the in- 
strument must be reversed ; by not observing 
these directions,the wombmay be seriously injured, 
which has often occurred, by those unacquainted 
with the anatomy of the parts. After the instru- 
ment has reached the upper part of the uterine 
cavity, it is to be turned, by a gradual rotary motion, 
until the womb occupies its natural position. These 
cases of misplacement are usually of the chronic 
form, having existed a long time before any thing 
is done to correct them ; in the mean time, the bent 
portion of the neck of the womb has become alter- 
ed in texture, or weakened, together with a relaxed 
condition of the ligaments, which allows the uterus 
to fall back again. The womb being turned over, 
becomes engorged or congested, even if this condi- 
tion did not exist before the misplacement, which 
is often the case ; it is, therefore, larger and heavier 
than natural, and the weak supports are unable to 
maintain it in its due position, after being placed 
there. The misplaced womb may be bound down 
by adhesions, so that it cannot be elevated without 
tearing it loose. These several difficulties are often 
met with, particularly in retroflexion, which makes 
the cure a slow and tedious affair. 

A retroverted womb may be kept in its natural 
position, by some kind of a pessary, and such as 
was recommended for falling of the womb, will 
probably answer the purpose ; it has this advantage 



120 THIRTY YEARS OF FEMALE LIFE. 

over many others, the woman can make and use it 
herself; she can also be instructed to frequently 
push the neck of the womb backwards and upwards ; 
in the meantime, if there is congestion or engorge- 
ment of the body of the organ, resort to the treat- 
ment recommended under that head. 

But in retroflexion, the mouth of the womb, if not 
in its natural position, is nearly so ; in these cases, 
pessaries do little good, and the woman cannot assist 
in the replacement, as in the former case. 

In cases where the womb is turned over in front, 
and pressing against the bladder, if the woman lie 
on her back, it assists in restoring the organ to its 
natural position ; but in retroflexion, the reverse is 
the case. She should therefore assume the opposite 
position, lying on the face, or on the knees and 
elbows. This position being more irksome than 
that recommended for anteflexion, it is apt to be dis- 
continued so soon, that less benefit is derived than 
otherwise would occur, if it could be maintained 
longer. As long as the womb remains in a conges- 
ted or engorged condition, it will not be very likely 
to assume its right place in the pelvis, even if it 
should be frequently replaced ; it is, therefore, of 
the first importance to overcome the congestion by 
appropriate treatment. Cold hip or sitz baths 
do good many times, also injections of cold water 
up the rectum. The leucorrhoea will require its 
appropriate treatment. The bowels should be kept 
regular by gentle aperients ; some cases may re- 
quire general bleeding, or local, by cupping or leech- 



THIRTY YEARS OP FEMALE LIFE. 121 

ing. As the general health is more or less affected 
in all these misplacements of the Avomb, tonics will 
be required. 

Inversion of the womb. — The several mal-posi- 
tions ot the womb, which have been considered, 
being of common occurrence, and often easily cured, 
differs widely from the one now under consideration 
being of rare occurrence, and one of the most se- 
rious accidents that can happen to a woman, as it 
usually results in the most fatal consequences. 

Inversion, is a turning of the womb inside out, 
as you would turn the finger of a glove, and can 
only happen when the organ has attained a consid- 
erable size, as in the latter months of pregnancy, 
or from a tumor attached to the upper portion of 
the womb ; in either case, it is of rare occurrence, 
and most frequently met with soon after child-birth. 
The inversion may be partial or complete ; in the 
former, the upper portion, instead of being concave, 
becomes more or less convex, or depressed toward 
the external opening ; in the latter, it is turned in- 
side out, and appears at the external orifice, or it is 
forced entirely without the body. 

" The mechanism of an inversion of the womb 
is very easy to be understood. The fundus of the 
organ, which is carried downwards, by whatever 
cause, is depressed so as to become convex within, 
instead of concave, as in its natural state. This de- 
pression increases by insensible degrees, and pass- 
es, with more or less haste, through the different 
stages of inversion. As the internal face sinks 



122 THIRTY YEARS OF FEMALE LIFE. 

lower and lower, it drags with it the ligamenta lata, 
and ligamenta rotunda/' (round and broad liga- 
ments) '^ the ovaries and the fallopian tubes which, 
as we have before said, take the place that have 
remained void in the pelvis. Inasmuch as the 
womb ; immediately after labor, is in a condition 
most favorable to the occurrence of an inversion, 
that, in fact, is the crisis at which such an event is 
most likely to happen ; for it never could happen, 
except in consequence of a distension of the walls 
of the womb, caused either by the presence within 
it of an ovum, a polypus, or a mole, or the accumu- 
lation of a quantity of the serum of the blood with- 
in its walls. ^'^ 

A polypus tumor, attached to the upper portion 
of the womb, may, by its size and weight, gradually 
force its way through the neck and mouth of the 
womb, until it falls without the body, dragging the 
uterus with it in an inverted condition ; or where 
the polypus has only entered the vagina, the inver- 
sion may be induced, by the efforts of the operator 
to remove the tumor, also by pulling at the cord to 
remove the after-birth, while the womb was uncon- 
tracted, has produced the misplacement. 

" The most common cause of inversion consists in 
attempts to deliver the placenta immediately after 
the birth of the child, and before the womb has 
become contracted. 

2. Too powerful efforts of traction upon the cord, 
while the placenta is still attached to the womb, 

*Colombat on Females, page 181. 



THIRTY YEARS OF FEMALE LIFE. 123 

and the pressure of the intestines upon the fundus 
at the same time. 

3. The prolonged efforts at bearing down, that 
some women make after the birth of the child, with 
a view more speedily to expel the placenta. 

4. The spontaneous, violent delivery of the pla- 
centa, as happens when women are delivered in a 
standing posture, which often causes the sudden 
and simultaneous escape of the entire product of 
the conception, particularly if the umbilical cord 
happens to be too short, or twisted round the child's 
neck or body. Under these circumstances, should 
the placenta be adherent, and fail to become detach- 
ed, or should the cord not break, an inversion would 
be the almost inevitable consequence."^ 

It may also occur when there has been no 
traction on the cord, but from irregular contraction 
of the womb. 

Symptoms.—" While in simple depression of the 
fundus of the uterus, the morbid symptoms are lim. 
ited to hemorrhage, which is sometimes very violent ; 
the patient experiences, when the inversion is com- 
plete, especially if it is rapidly produced, a violent 
pain radiating from the uterus toward the sacrum 
and the groins. Often, at the same time, all the 
symptoms of a profound exhaustion of the functions 
of the nerves and the vessels are observed, such as 
repeated vomiting, syncope, violent chills, convul- 
sive movements of various muscles, a peculiar ex- 
pression of pain and anguish in the features of the 

♦ Colombat on Females, page 181. 



124 THIRTY YEARS OF FEMALE LIFE. 

the countenance, etc. The vessels ending at the 
point where the placenta was adherent, remaining 
open, there flows out a considerable quantity of 
blood ; and if this is not promptly remedied, the 
patients succumb with all the symptoms of anaemia. 
The symptoms are very different when the inversion 
is formed little by little, in consequence of an an- 
terior depression of the uterus. The phenomena 
resulting from the shock to the nervous system, are 
here entirely absent, and the exit of the fundus 
uteri out of the os tincae, or the vulva, is accom- 
panied by more or less hemorrhage, repeated at 
unequal intervals ; by continual pains in urinating, 
or in going to stool ; by painful contractions of the 
uterus, spreading toward the sacrum and the groins ; 
by gastralgia, and the numerous troubles which are 
developed in the course of ana3mia."'^ 

" When the uterus has become inverted, immedi- 
ate hemorrhage takes place, which is quickly fol- 
lowed by faintness, and a sense of fullness in the 
vagina ; and in the greater number of instances, 
almost by immediate dissolution.'^t 

Death may also take place from the shock to the 
nervous system. If the woman survive the acute 
inversion of the womb, it may remain inverted for 
years, constituting the chronic form of this malady, 
and characterized by more or less inconvenience, 
distress and suffering. 

"The patient is subject to occasional irregular 

*Scanzoni on Diseases of Females, page 137. 
f Newnham's essay on Inversion, page 86. 



THIRTY YEARS OF FEMALE LIFE. 125 

hemorrhages, and to a constant profuse mucous dis- 
charge, during the intervals, Every month, the 
surface,^' (of the womb) " is observed to be cover- 
ed with red drops, which are, in fact, the menses. 
The patient complains of pain, a sensation of weight 
in the pelvis, and dragging from the loins. If the 
uterus protrude through the external parts, its sen- 
sibility will gradually diminish, in consequence of 
the formation of a kind of epithelium upon its 
surface ; and if it be exposed to rude contact, or if 
acrid secretions are allowed to accumulate upon it, 
circumscribed inflammation may occur, followed by 
ulceration, either superficial or profound, and involv- 
ing some danger to the patient, if not remedied. 
The constitution of the patient sympathizes deeply 
with so extraordinary an accident. After recovery 
from the state of exhaustion, or nervous depression 
into which she was at first thrown, the repeated 
hemorrhages and constant leucorrhoea will render 
her countenance pale and exsanguined, and subject 
her to various secondary symptoms, such as syncope, 
dropsical efiusions, hectic, &c.^^* 

In some rare cases, it is recorded that females 
have carried around with them in their daily avoca- 
tions, an inverted womb, and suff'ered little incon- 
venience or distress ; illustrating, in the most em- 
phatic manner possible, that want of sympathy 
between different organs, which has previously 
been referred to. In this connection. Dr. West 
mentions a case, " recorded by Boivin and Dug6s, of 

♦Churchill on Diseases of Women, page 328. 



126 THIRTY YEARS OF FEMALE LIFE. 

a woman, who was brought to one of the hospitals at 
Paris, six days after a labor, in which her womb 
had become inverted. Repeated efforts were made 
by M. Dubois, as Avell as by Madame Boivin herself, 
to replace the womb, but without success ; and no 
symptoms being at the time present, the patient 
returned into the country by diligence, on the 
eighteenth day after her delivery. Nothing more 
was heard of her till five years afterwards, when 
she presented herself to Madame Boivin, with her 
uterus still inverted, though smaller in size than be- 
fore. Some sense of dragging at the groins, a fre- 
quent desire to pass water when she was up, and 
exerting herself, and a discharge of a reddish mucus, 
recurring every fifteen or twenty days, and lasting 
for a few hours, were the only symptoms from which 
she suffered."* 

Other similar cases are mentioned by different 
authors, substantiating the singular fact, that an in- 
version of the womb may exist for a long time, 
without giving rise to symptoms that usually occUr, 
and would be naturally expected in all cases, from 
a knowledge of the parts concerned in the mis- 
placement. 

Treatment. — This will be modified according to 
whether the inversion is partial or complete, acute 
or chronic. If it occurs immediately after delivery, 
and the after-birth is not attached, the inverted or- 
gan is to be grasped with the hand well lubricated, 
and carried up through the os uteri, until it is en- 

*West on Diseases of Women, page 183. 



THIRTY YEARS OP FEMALE LIFE. 127 

tirely replaced ; then, before removing the hand, 
eflforts should be made to bring on contractions of 
the womb; the hand may then be gradually removed; 
the presence of the hand in the uterine cavity, will 
frequently induce strong contractions, and expel it. 
If the after-birth is still attached to the inverted 
womb, some authors recommend 'removing it before, 
and others after replacing the organ. This part of 
the operation should be conducted according to cir- 
cumstances. If it would not be losing valuable 
time, the after-birth had better be removed before 
attempting to replace the womb, as the efforts to 
remove it, might induce an inversion the second 
time. After being replaced, and uterine contrac- 
tions established, the patient should be closely 
watched, and such anti-spasmodics, nervines and 
stimulants administered as the particular symptoms 
seem to indicate. If, upon careful examination, the 
womb is found to be partially inverted, it may be 
corrected by the uterine sound, or some similar 
instrument. 

^' In cases of chronic inversion of the uterus, it is 
ordinarily necessary to precede any attempt at re- 
duction, by treatment intended to get rid, first, of any 
pathological alterations which the womb may pre- 
sent. For the proper treatment, we may refer to 
the chapter on chronic engorgement. When a vo- 
luminous polypus is the cause of the inversion, it is 
always necessary to remove it before attempting 
the reduction. But if these attempts are fruitless, 
and the reduction is impossible, we ought always to 



128 THIRTY YEARS OF FEMALE LIFE. 

attempt to push into the vagina, the portion of the 
uterus appearing opposite to the vulva, and to re- 
tain it there, by means of proper apparatus, in or- 
der to protect it against external influences."^ 

For this purpose, the bandage recommended in 
falling of the womb, will answer the purpose. 
Chronic inversion of the womb is rarely replaced ; 
even a few hours has often been sufficient to render 
a replacement of the organ impossible by art, yet it 
has occurred spontaneously, after being inverted 
many months. Dr. Meigs mentions two cases, and 
others are related by several medical authors. 
There is no doubt that a polypus has been many 
times mistaken for the inverted womb, and may 
have been removed for one, by the knife or ligature; 
yet, it is not probable, that Dr. Meigs would make 
such a mistake, as he has great experience, and is 
abundantly able to diagnose correctly abnormal 
growths of the female reproductive organs. 

" Distension and inflammation of the bladder may 
occur, involving considerable danger. The invert- 
ed uterus may be strangulated, and be separated by 
sloughing or gangrene, with great danger, although 
cases are on record, where this termination issued 
favorably.^t 

"This being the case, there is every encourage- 
ment, within certain limits, to effect that removal 
by art, which nature thus so beneficially accom- 
plished. In this opinion. Sir C. Clarke fully coin- 

*Scanzoni's Diseases of Females, page 141. 
f Churchill's Diseases of Women, page 329. 



i 



THIRTY YEARS OF FEMALE LIFE. 129 

cides. He observes : — * In those cases of inversion 
of the uterus, where the woman has passed the 
menstruating age, when her comfort is destroyed by 
the disease, and when the profuseness of the dis- 
charge threatens her with death, from the debility 
which it produces, it may be advisable to recom- 
mend the performance of an operation, which has 
been attended with success, viz., the removal of the 
inverted uterus itself/ How far it may be right to 
resort to this operation during the menstruating 
part of a woman's life, the author has no means of 
judging. The operation, however, has been per- 
formed during the menstruating part of a woman's 
life, with complete success. We may, therefore, 
conclude that the operation is perfectly justifiable^ 
provided that the patient is in a fit state of health 
for an operation ; and secondly, that the uterus be 
not afi'ected with scirrhus or cancer.''^ 

The operation consists in passing a single ligature 
around the neck of the tumor, or the ligature may 
be passed through it double, tying both ways, which 
produces strangulation, and the inverted mass 
drops off in about two weeks. In some cases, the 
pain and other symptoms caused by the ligature, is 
so distressing, that it is necessary to loosen it until 
they have subsided, when it is again tightened, re- 
peating this process until the tumor is removed. 
Tonics and stimulants will be required to keep up 
the vital powers, and emolient or astringent washes 
to correct the discharge. The 'after treatment will 

♦Churchill on Diseases of Women, page 337. 



130 THIRTY YEARS OF FEMALE LIFE. 

be modified according to the condition of the 
patient. 



CHAPTER XV. 

IRRITABLE UTERUS. 

The credit of first describing this complaint of 
the womb, is unreservedly given to the late Dr. 
Gooch, and it still retains the name by which he re- 
cognized it. The following is his description of it. 

" A patient, who is suffering from irritable uterus, 
complains of pain in the lowest part of the abdo- 
men, along the brim of the pelvis, and often, also, in 
the loins. The pain is worse when she is up, and 
taking exercise, and less when she is at rest in the 
horizontal posture ; in this respect, it resembles 
that of prolapsus uteri ; but there is this difference, 
that in the latter, if the patient lies down, she soon 
becomes quite easy, but in the complaint of which 
I am speaking, the recumbent posture, although it 
diminishes, does not remove the pain. It is always 
present in some degree, and severe paroxysms often 
occur, although the patient has been recumbent for 
a long time. 

" If the uterus is examined, it is found to be ex- 
quisitely tender ; the finger can be introduced into 
the vagina, and pressed against its sides, without 



THIRTY YEARS OF FEMALE LIFE. 131 

causing uneasiness, but as soon as it reaches, and is 
pressed against the uterus, it gives exquisite pain. 
This tenderness, however, varies at different times, 
according to the degree of pain which has been lat- 
terly experienced. The neck and body of the uter- 
us feels slightly swollen, but this condition also ex- 
ists in different degrees, sometimes sujSiciently 
manifest, sometimes scarcely, or not at all percepti- 
ble. Excepting, however, this tenderness, and oc- 
casionally, this swelling, or rather tension, the uter- 
us feels perfectly natural in structure ; there is no 
evidence of scirrhus in the neck, the orifice is not 
mis-shapen, its edges are not indurated. The pa- 
tient, finding her pain greatly increased by rising 
and walking, soon learns to relieve herself, by lying 
on the sofa, and at length spends nearly her whole 
time there. Notwithstanding this precaution, there 
is always a considerable degree of uneasiness, but 
this frequently increases to severe pain. These 
paroxysms generally come on, either a few days be- 
fore menstruation, or (as is the case in ma"fiy in- 
stances) a few days afterwards. If the paroxysm is 
properly treated, it subsides in a few days to the or- 
dinary and more moderate uneasiness. Whilst this 
uneasiness is felt in the substance of the uterus, the 
general circulation is but little disturbed. The 
pulse is soft, and not much quicker than is natural ; 
but it is easily quickened by the slightest emotion. 
In a few instances, however, there has been a great 
and more prominent excitement of the general cir- 
culation : the degree in which the health has been 



132 THIRTY YEARS OF FEMALE LIFE. 

reduced, has been different in different cases. A 
patient who was originally delicate, who has suffered 
long, and has nsed much depleting treatment, has 
been (as might reasonably be expected,) the most 
reduced ; she has grown thin, pale, weak and ner- 
vous ; menstruation often continues regular, but 
sometimes diminishes, or ceases altogether ; the 
functions of the stomach and bowels are not more in- 
terrupted than might be expected from the loss of air 
and exercise; the appetite is not good, and the bowels 
require aperients ; yet nothing more surely occa- 
sions a paroxysm of pain than an active purgative. 
Such are the leading symptoms of this distressing 
complaint. And to embody them in one view, let the 
reader fancy to himself a young or middle-aged 
woman, somewhat reduced in flesh and health, al- 
most living on her sofa for months, or even years, 
from a constant pain in the uterus, which renders 
her unable to sit up and take exercise ; the uterus, 
on examination, unchanged in structure, but exquis- 
itely tender ; even in the recumbent posture, always 
in pain, but subject to great aggravations, more or 
less frequently."* 

According to Dr. Gooch, this abnormal condition 
of the womb, which he has described, is not a chronic 
inflammation of the organ. This statement, how- 
ever, is disputed by good medical authority, and 
apparently the disputations are well sustained. 
Dr. Gooch says also, "I took it for chronic in- 
flammation, which would end in disorganization, 

* Gooch on Diseases of "Women, page 267. 



THIRTY YEARS OF FEMALE LIFE. 133 

probably of a malignant kind ; but experience, 
whilst it taught me that it was a very intractable 
disease, taught me also, that it was not a disorgan- 
izing one."* 

Chronic inflammation of the womb is often of 
that low grade, existing, as in irritable uterus, for 
years, without producing sufficient disorganization 
of the tissues of the womb, to be discovered during 
the life of the patient ; yet, this low grade of in- 
flammation may produce the most intense suff'ering, 
in some cases, particularly of a nervous or hysteri- 
cal temprement. Some females, also, suffer severe 
pain from a very slight misplacement of the womb, 
and others experience little or no inconvenience 
when the womb is greatly out of place, or even at- 
tacked with malignant disease. Whether regard- 
ed as inflammatory or not, the treatment of irrita- 
ble uterus does not difl'er materially from that re- 
commended for chronic inflammation of the womb, 
together with hyoscyamus and camphor, ammoni- 
ated tincture of valerian and other anti-spasmodics, 
as in hysteria. 

*Gooch on Diseases of Women, page 266 



134 THIRTY YEARS OP FEMALE 'LIFE. 



CHAPTER XVI. 

HYSTERIA. 

This Protean malady of the female organism, 
presents itself under many different forms, modi- 
fied somewhat, by the state of the patient ; wheth- 
er of a robust or plethoric habit, or of a weakly en- 
feebled constitution. It not only presents pheno- 
mena peculiar to itself, but it may also assume the 
form and symptoms of other complaints, at the 
caprice of the patieiit, or she may not be able to 
restrain her feelings or control her actions. Hys- 
teria usually occurs between the fifteenth and forty- 
fifth years of age, whether married or single, rarely 
before puberty, or after menstruation has finally 
ceased ; but is frequently met with about the time 
menstruation commences, and at the turn of life. 
The causes of hysteria are as various as the subjects 
of it are numerous. It is said to be hereditary, but 
more properly speaking, the constitutional peculi- 
arity observed in hysteric patients is hereditary. 
The disease, not unfrequently,is developed by sym- 
pathy in families, schools, or in the wards of a hos- 
pital, as the following illustrations show. A mother 
has an attack of hysteria, her daughter being pres- 
ent, and witnessing her apparent suffering, is also 
seized with the same complaint. 



THIRTY YEARS OF FEMALE LIFE. 135 

" M. Andral relates the case of a young girl, who 
at a boarding school, fell into a paroxysm of hys- 
teria in the presence of her companions ; soon after, 
so large a number were attacked with the same 
disease, as to make it necessary to close the school 
for a considerable period/'^ 

Dr. Watson states, that a case of hysteria, occur- 
ring in the wards of a hospital, is often immediately 
followed by a number of others similarly affect- 
ed. Hysteria is often observed in females affected 
with chlorosis, and those who suffer from menstrual 
diflSculties ; painful menstruation being often at- 
tended with hysteric paroxysms. Colombat men- 
tions as causes, '' Uterine plethora; abuse of coitus ; 
forced continence ; masturbation ; and all circum- 
stances capable of producing, maintaining, or in- 
creasing irritation of the uterus, and especially of 
the ovaries. The disease may also have, as excit- 
ing causes, the instinct of imitation, the vivid emo- 
tions of the soul, such as transports of anger, fright, 
violent and sudden disappointment, the uneasiness 
produced by love, the reading of highly wrought 
works, erotic conversation, the sight of some 
ghastly and bloodly spectacle, or of a licentious 
scene, the impression produced by a tragical rep- 
resentation, or by sombre, mysterious, pathetic or 
too animated music.'^t 

Women of a very sensitive, nervous organization 
are more predisposed to hysteria than others, their 

♦ Colombat on Females, page 526. 

f Colombat on Diseases of Females, page 526. 



136 THIBTY YEARS OF FEMALE LIFE. 

feelings are easily hurt by a word, or look, when no 
offence was intended, or some fancied slight or ne- 
glect, or something wrong in their household affairs, 
and a fit of hysteria is the result ; the most trivial 
circumstances causing them to laugh or cry, at times 
all gaitey and mirth, at others sad and melancholy. 
Hysteric females often suffer from cold hands and 
feet, indicating a deficient nervous force, and un- 
equal circulation. This complaint is much oftener 
met with amongst females living in cities, than 
the country ; in fact, it may be said to be common 
in the one case, and rare in the other. This great 
difference depends upon the mode of living, and 
course pursued in the education of female children, 
to a very great extent ; girls in the city are too 
much confined in crowded school-rooms, over taxed 
with studies, and deprived of that amount of out- 
door exercise required by all young creatures, to 
develope a healthy organization. On this subject. 
Sir Benjamin Brodie very happily remarks, as fol- 
lows : " you can render no more essential service to 
the more affluent classes of society, than by avail- 
ing yourselves of every opportunity of explaining 
to those among them who are parents, how much 
the ordinary system of education tends to engender 
the disposition to these diseases among their female 
children. If you would go further, so as to make 
them understand in what their error consists, what 
they ought to do, and what they ought to leave un- 
done, you need only point out the difference between 
the plans usually pursued in the bringing up of the 



THIRTY YEARS OF FEMALE LIFE. 137 

two sexes. The boys are sent, at an early age, to 
school, where a large portion of their time is pass- 
ed in taking exercise in the open air ; while their 
sisters are confined to heated rooms, taking little 
exercise out of doors, and often none at all, except 
in a carriage. Then, for the most part, the latter 
spend much more of their time in actual study than 
the former. The mind is over educated, at the ex- 
pense of the physical structure ; and after all, little 
advantage to the mind itself ; for who can doubt, 
that the principal object of this part of education 
ought to be not so much to fill the mind with know- 
ledge, as to train it to a right exercise of its intel- 
lectual and moral faculties ; or that, other things 
being the same, this is more easily accomplished in 
those whose animal functions are preserved in a 
healthy state, than it is in others/' 

It is quite probable, that the predisposition to 
hysteria, in the majority of cases, is acquired in con- 
sequence of the habits of the female. In cities and 
large towns, a large proportion of the female pop- 
ulation are obliged to support themselves, as soon 
as they are old enough, (and often before) by some 
occupation, often a sedentary one, which induces 
habitual constipation, and as a necessary conse- 
quence, indigestion also, which is a frequent cause 
of hysteria. Several other causes are mentioned, 
as cold, resulting in checking perspiration, or sup- 
pressing the monthly flow, suppression of the lo- 
chia, leucorrhoea, and piles. 

Symptoms. — As it may affect females of almost 



138 THIRTY YEARS OF FEMALE LIFE. 

every age and condition in life, the symptoms as- 
sume a variety of modiiScations, which are some- 
times divided into convulsive and non-convulsive» 
and these again divided, by some authors. Yet, as 
often happens, in a hysteric paroxysm, the different 
forms are frequently observed to a greater or less 
extent, and for the sake of convenience, they may 
be considered together. At the commencement of 
the paroxysm, in many cases, the patient complains 
of faintness, and weakness at the pit of the stomach, 
confusion of ideas, ringing in the ears, and a sensa- 
tion of fullness in the lower part of the abdomen ; 
a ball appears to move about, mounting up to the 
stomach, where it seems to shoot up to the throat, 
producing a sensation of choking or suffocation. 
Some patients declare that they have felt the ball 
in their stomach dart up their neck, on one side, as 
high as the ear, where it explodes with a loud noise. 
They often complain of pains in different parts, as 
under the left breast, at the top of the head, or just 
over one eye, in the ovarian region, severe colics, 
and weight in the pelvis, and bearing down, rumb- 
ling noise in the bowels, and belching up of wind. 
Convulsive movements finally come on ; she throws 
her arms wildly about, yawns and sighs, utters 
piercing shrieks, strikes her chest with her clenched 
fists, or clutches at her throat, tears open her dress, 
pulls her hair, and attempts to bite herself and 
those near her, draws up her legs, and then immedi- 
ately thrusts them down again with a \^olent mo- 
tion, rises up from a sitting posture, then throws 



THIRTY YEARS OF FEMALE LIFE. 139 

herself down again ; or if sitting in a chair, will fre- 
quently slide out of it on to the floor, writhes and 
twists about with such force, that it is as much as 
two or three persons can do, to prevent a 
weak, frail woman, from throwing herself from 
the bed, and injuring herself. The head is thrown 
back, the jaws firmly shut, the eyes closed and 
tremulous, the breathing laborious, or the act of 
filling the lungs performed at long intervals, the 
nostrils dilated, the abdominal muscles violently 
contracted, then relaxed ; when the attack is about 
passing off*, the jaws relax, she opens her eyes, and 
looks wildly about, or sighs, moans, or bursts into 
immoderate laughter, or cries violently. In some 
cases, the first intimation of the paroxysm coming 
on, the patient is seized with a violent fit of laugh- 
ing or crying, followed by shrieks at the top of her 
voice ; she throws herself violently on the floor, 
moans, or falls into a state of insensibility, which 
lasts a few minutes or several hours, from which she 
seems to awake, as though nothing had occurred. 
In some cases of a full or plethoric habit, the face is 
flushed, a redness about the neck, hurried respira- 
tion, the heart beats violently, with throbbing of 
the temples, the veins of the neck swollen and 
turgid, the pulse quick and bounding, pain in the 
head, and delirium sometimes supervenes. In 
weakly women, the opposite condition is more fre- 
quently observed ; the pulse is hardly perceptible, 
she complains of chilliness, the extremities are cold, 
the face pale and cold, and in some cases, there is 



140 THIRTY YEARS OF FEMALE LIFE. 

sickness of the stomach and vomiting. After the 
hysteric paroxysm is over, the patient often passes 
a large quantity of pale, colorless urine, and some- 
times this odcurs while the fit is on them. The at- 
tack sometimes comes on very suddenly, a cross 
word, anger, fright, good or bad news, being quite 
sufficient, with some women, to induce it. The 
hysteric paroxysm is sometimes preceded by a feel- 
ing of weakness, pain in the head or limbs, with 
coldness of the extremities, melancholy, numbness 
and cramp in the legs, yawning, and uneasy, restless 
feelings. Some women know by these and other 
sensations, which they are in the habit of having, 
that an attack is approaching, but are not often able 
to prevent it. 

Hysteric subjects are often melancholy ; when in 
company, they frequently assume a cheerfulness 
they do not feel ; they prefer to be alone, sigh 
much, are sad, and cannot tell why ; they think too 
much, and do not take sufficient out door exercise. 
It is common for women, subject to hysteria, to 
manifest some of the symptoms peculiar to this 
complaint, whenever they are sick from a confine- 
ment, or any otter illness. In treating a case of 
this character, before forming an opinion in regard 
to it, the symptoms should be well analyzed, and 
not give too much importance to those of a hysteric 
nature, for hysteria rarely results fatally, although 
it often assumes symptoms of a very grave and seri- 
ous character, and may mask those of really, more 
consequence. Although an attack of hysteria usu- 



THIRTY YEARS OF FEMALE LIFE. 141 

ally terminates within a few minutes, or a few 
hours, cases are related by Colombat and others, 
where it has lasted a number of days ; the person 
remaining in a lifeless condition so long, pulseless 
and breathless, that they have been considered ac- 
tually dead, and preparations have been made for 
their burial. In this connection, the following is 
from a note on page 531 of Colombat's work on 
Females. 

*^ The Journal des Savants, for the year 1745, 
reports the case of Lady Russell, whose body re- 
mained for eight days without giving the slightest 
appearance of life, or the least sign of alteration. 
This person, who lived a long time after, was arous- 
ed by the sound ofthe bells of a neighboring church, 
whilst her husband, who vehemently opposed her 
inhumation, was holding her hand and bathing it 
with his tears. Joseph Raulin (Traite des effect, 
vapor, 1758) speaks of a hysterical girl, whose fu- 
neral he postponed, because her color had not en- 
tirely changed. The author adds, that in the course 
of a few hours the supposed corpse recovered her 
consciousness.^' 

Such cases should not be considered as hysterical, 
they belong more properly to that curious malady 
called catalepsia, of which they form a very good 
type. Those subject to catalepsia, are usually fe- 
males, and subject to hysteria ; the two complaints 
alternating, sometimes hysteria terminating in ca- 
talepsia, and the latter assuming the hysteric form. 
Dr. Gooch relates an interesting case of catalepsia, 



142 THIRTY YEARS OF FEMALE LIFE. 

showing some of the peculiarities of this singular 
complaint. The patient was attended by Dr. Suth- 
erland and Dr. Gooch ; the latter remarks as fol- 
lows : " A few days after our first visit, we were 
summoned to observe a remarkable change in her 
symptoms ; the attendants said she was dying, or 
in a trance ; she was lying in bed, motionless, and 
apparently senseless. It had been said that the 
pupils were dilated, and motionless, and some appre- 
hension of effusion on the brain had been enter- 
tained ; but on coming to examine them closely, it 
was found that they really contracted when the 
light fell upon them ; her eyes were open, but no 
rising of the chest, no movements of the nostrils, 
no appearance of respiration could be seen ; the 
only signs of life were her warmth and pulse ; the 
latter was, as we had hitherto observed it, weak^ 
and about one hundred and twenty. '^ 

" The trunk of the body was now lifted, so as to 
form rather an obtuse angle with the limbs (a most 
uncomfortable posture) and there left with nothing 
to support it ; there she continued sitting, while we 
were asking questions and conversing ; so that many 
minutes must have passed. One arm was now rais- 
ed, then the other ; and where they were left, there 
they remained. It was now a curious sight to see 
her, sitting up in bed, her eyes open, staring life- 
lessly, her arms out-stretched, yet without any visi- 
ble sign of animation. She was very thin and pal- 
id, and looked like a corpse that had been propped 
up, and had stiffened in this attitude. We now took 



THIRTY YEARS OP FEMALE LIFE. 143 

her out of bed, placed her upright, and endeavor- 
ed to rouse her by caUing loudly in her ears ; but 
in vain. She stood up, but as inanimate as a statue. 
The slightest push put her off her balance. No 
exertion was made to regain it, she would have fall- 
en if I had not caught her." " She went into this 
state three several times. The first time it lasted 
fourteen hours, the second time twelve hours, and 
the third time nine hours ; with waking intervals 
of two days after the first fit, and one day after the 
second. After this, the disease resumed the ordi- 
nary form of melancholia ; and three months from 
the time of her delivery, she was well enough to re- 
sume her domestic duties." 

An important feature of hysteria, resembling 
catalepsia, and dissimilar from epilepsia, with which 
it is sometimes confounded, is the faculty of con- 
sciousness, often observed. A patient laboring un- 
der an attack of hysteria, may to all appearances, 
be perfectly dead to all surrounding objects, but 
when the paroxysm is over, she is able to tell much 
that has transpired ; the remarks made by those 
around her, particularly if they refer to herself, so 
that persons attending to a woman in a fit of hy- 
steria, should be careful not to make remarks they 
do not wish her to hear, for, although apparently 
unconscious, she may hear and understand all that 
is said. 

Hysterical subjects sometimes go many days with- 
out partaking of food, under the impression that 
they cannot eat, or in consequence of a morbid 



144 THIRTY YEARS OF FEMALE LIFE. 

condition of the nerves of the stomach ; the very 
sight of food produces nausea and vomiting. 
Dr. Carpenter says '' In certain states of the system 
commonly known as hysterical, there is frequently a 
very remarkable disposition for abstinence, and 
power of sustaining it. In a case of this kind 
which occurred under the author^s own notice, a 
young lady, who had suffered severely from the te- 
tanic form of hysteria, was unable to take food for 
three weeks. The slightest attempt to introduce a 
morsel of solid matter into the stomach, occasioned 
very severe vomiting and retching ; and the only 
nourishment taken during the period mentioned, 
was a cup of tea once or twice a day ; on many 
days not even this being swallowed. Yet the 
strength of the patient rather increased than dimin- 
ished during this period ; her muscles became firm- 
er and her voice more powerful."^ 

In some of these cases, great deception is prac- 
ticed, the patient refraining from taking food when 
any one is present, but managing to obtain it slily, 
secreting it about their person or bed, and when 
alone and unwatched, devour it. Under such cir- 
cumstances, it is easy to understand why such pa- 
tients do not lose flesh. Hysteria also simulates 
important diseases. It very frequently assumes 
the form of peritonetis, with some of the promi- 
nent symptoms of that serious disease. In such 
cases, she will complain of great soreness of the 
abdomen, the weight of the bed-clothes, or the 

* Carpenter^s Human Physiology, page Z5Q, 



THIRTY YEARS OF FEMALE LIFE. 145 

slightest touch, causing her to cry out with pain ; 
yet if the hand is pressed firmly upon the bowels, 
the pain is hot aggravated. Often when the finger 
is brought near the part complained of, she will 
shrink as though actually touched. It may be the 
spine, the hip, or the joints of the knees of which 
she complains, the same peculiarities are observed 
in either case, and patients have been confined to 
the bed for many months, and treated for a serious 
disease ot the spine, hip or some other part, when 
the difficulty was simply an irritable condition of 
the nervous system, peculiar to hysteric patients, 
localized by the powers of imagination. And cases 
have occurred, where they had apparently been 
unable to walk for months, but on the reception of 
good news, or a fright, the disease has been cured 
instanter. 

Treatment. — When the female is attacked with a 
fit of hysteria, if any portion of the dress interferes 
with the movements of the chest, or impedes the 
circulation, it should be immediately removed, then 
give a tea-spoonful of the tincture of valerian — the 
amoniated tincture is best — in a wine-glass of sweet- 
ened water. If the jaws are firmly set, cold applied 
to the cheeks, as a piece of ice on each side, will 
often relax the muscles, so that the mouth can be 
opened, or it may be pried open ; if the medicine 
can be got into th^ mouth, she can swallow it. 
Pouring cold water on the head and face will fre- 
quently break the paroxysm. If the patient is of a 
full habit, bleeding will be of the first importance. 



146 THIRTY YEARS OF FEMALE LIFE* 

In all cases, if she is in the recumbent posture, the 
head should not be too low, and she should have 
free access to cool, fresh air ; to ensure this, the 
window may be opened, and no persons allowed 
near the patient, except those absolutely necessary 
to render her assistance. 

Few remedies have produced such good results 
in any disease, as the preparations of valerian in 
hysteria, yet a number of others are often resorted 
to with benefit. Thus, chloroform is sometimes 
used, and sulphuric ether, one tea-spoonful in half a 
wine-glassful of sweetened water. Laudanum, opi- 
um, morphine, or what suits some patients better, 
the acetic tincture of opium, fifteen drops in a little 
water. Hartshorn held under the nostrils, and an 
old remedy, often resorted to in times past, was al- 
lowing the patient to inhale the fumes of burnt 
feathers and the like, or half a tea-spoonful of the 
tincture of lobelia, in a little water, will frequently 
mitigate the spasmodic action. In some cases, a 
mustard plaster to the lower part of the bowels 
will do good ; if there is nausea and vomiting, apply 
a mustard plaster over the stomach; a few drops of 
spirits of camphor and water, or ammonia and water, 
is sometimes of service, or tincture of hyoscyamus 
and camphor, tincture of asafoetida, also cold water 
injections up the rectum, or an injection of half a 
tea-cupful of thin starch, with half an ounce of spirits 
of turpentine, or half an ounce of tincture of asa- 
foetida, or a tea-spoonful of laudanum. When the at- 
tack is preceded by premonitory symptoms, as fre- 



THIRTY YEARS OF FEMALE LIFE. 147 

quently happens, some of the above remedies wil] 
often prevent it. 

As constipation is often associated with hysteria, 
the bowels should be freely opened by cathartic 
medicine, or injections, or both ; and when the pa^ 
roxysm is over, such treatment recommended aa 
tends to remove the cause of the attack, so far aq 
this can be ascertained. 

In weakly women, some of the preparations oi 
iron, and other tonics, will be required. Some fe- 
males subject to hysteria, complain of a pain in the 
brow, just over one eye, coming on like ague, every 
day, or every one, two or three days, at about the 
same hour each time ; for this often distressing 
pain, quinine will usually be sufficient, or quinine 
and iron will answer the purpose better, in some 
cases. Sulphuric ether is also a good remedy for 
this periodical pain. During the early months of 
pregnancy, hysteria is often observed in females of 
a nervous or hysteric disposition ; it rarely produces 
abortion. The symptoms and treatment will be the 
same, to a greater or less extent, as when the com- 
plaint occurs in the unimpregnated state. 



148 THIRTY YEARS OF FEMALE LIFE. 



CHAPTER XVn. 

TUMORS OF THE WOMB. 

Polypus of the Womb. — The womb is extremely 
liable to morbid growths, designated as polypus tu- 
mors, which may be attached to different portions 
of the organ, as the inner surface of the body, to 
the passage through the neck, or to the mouth of 
the womb, and are sometimes divided into mucous 
and fibrous polypus. These morbid fibrous growths 
are attached to the womb, in many cases, by a ped- 
icle or neck, which is usually much smaller than the 
body of the tumor. They are of various sizes, 
weighing, in some instances, several pounds, in 
other cases being no larger than a pea. 

" A polypus of the uterus, when discovered, is a 
tumor in the vagina, attached to some part of the 
uterus. It is round, smooth, firm and insensible ; it 
is quite unattached to the vagina, so that the finger 
can be pressed round, between the walls of the 
vagina and the part or stalk. This stalk is different- 
ly attached in different cases ; in some, it passes 
through the orifice of the uterus into its cavity, 
and is attached to the fundus of this organ ; in oth- 
ers, it passes into the cavity of the neck, to one side 
of which it is attached : in others, it does not 



THIRTY YEARS OF FEMALE LIFE. 149 

enter the orifice, but is attached to one portion 
of its edge, or lip ; hence, a distinction of 
polypus of the fundus, polypus of the neck, and 
polypus of the orifice. This distinction must not 
be lost sight of, for it is of practical consequence. 
In ascertaining the nature of the tumor, for the pur- 
pose of determining the propriety of removing it 
by an operation, the mode of its attachment is one 
of our chief guides ; and in this respect, what is 
true of polypus of the fundus, is not so of polypus 
of the neck or lip. In polypus of the fundus, the 
stalk is completely encircled by the neck of the 
uterus, and if the finger can be introduced into the 
orifice, it passes easily around between the stalk of 
the polypus and the encircling neck. In polypus 
of the neck, the finger cannot be passed quite 
around the stalk ; it may be passed partially around 
it, but it is stopped when it comes to that part 
where it is attached to the neck ; the stalk is only 
semi-circled by the neck. In polypus of the edge 
of the orifice, or lip, the stalk does not enter the 
orifice, but grows from the edge of it ; it feels as 
if a portion of the lip was first prolonged into the 
stalk, and then enlarged into the body of the 
polypus."^ 

Dr. Gooch has given a very lucid description of 
polypus in general, but they will in some cases, be 
of forms varying according to the pressure they 
receive from the surrounding parts, so that a poly- 
pus is not, under such circumstances, always round. 

* Gooch on Diseases of Women, page 218. 



"150 THIRTY YEARS OF FEMALE LIFE. 

They are said to possess more or less sensibility also, 
in some cases, though this peculiarity may be of 
more rare occurrence than the alteration in form. 

When the tumor grows within the uterine cavity^ 
the womb enlarges, producing alterations in its 
neck, similar to pregnancy, but when it is attached 
to the mouth or neck of the womb, this is not ob- 
served. 

"A polypus may be formed for several years be-* 
fore it is perceptible by any examination, and du- 
ring the whole time may occasion many untoward 
and intractable symptoms. Sometimes it may be 
discovered within the os uteri, through which it at 
length drops by its own gravity, or is excluded by 
pains similar to those of labor. A polypus has been 
unexpectedly found in the vagina, which had passed 
through the os uteri without pain. It has happen- 
ed, though rarely, that a polypus, though growing 
in the uterine cavity, does not always prevent con- 
ception, or much impede or obstruct parturition ; 
which polypus has been immediately expelled after 
the birth of the child.^'^ 

These polypi are covered by the mucous mem" 
brane, which lines the cavity of the womb, and are 
supplied with blood from the uterine vessels. The 
age when polypus of the womb is most frequently 
met with, is from thirty to forty years, then from 
forty to fifty ; younger females, either married or 
single, are frequently the subjects of these morbid 
growths. '' Dr. Simpson informs us, that Siebold 

*Denman's Midwifery, page 101. 



THIRTY YEARS OF FEMALE LIFE. 151 

has observed three polypi in the case of a girl with 
the hymen perfect."* 

Dr. Denman removed a polypus from a girl twen- 
ty two years old. 

They are, however, of rare occurrence under 
thirty or over fifty years of age ; these two periods 
being nearly equal in the frequency of their occur- 
rence. The cause of uterine polypus is shrouded 
in great obscurity ; some authors, Colombat and 
Churchill, consider as causes, punctures, abuses of 
coitus, tedious labors, inconsiderate manipulations 
for expediting delivery, and sedentary occupations. 
As they have sometimes occurred after abortions, 
it has been conjectured that a clot may have been 
retained in the uterus and have become organized- 

A portion of a retained placenta, whether from 
delivery at full term or abortion, seems a very prob- 
able cause. 

Symptoms. — Uterine hemorrhage, more or less 
severe, is usually the first symptom which attracts 
the attention of the patient ; at first, it is merely 
an aggravation of the monthly flow, increasing in 
severity from time to time, until there is little or 
no cessation, but a constant discharge of blood, as 
in the case related by Dr. Meigs, which continued 
over six years. Sometimes, when the tumor is sit- 
uated within the uterine cavity, the flow is accom- 
panied with occasional attacks of pain, like labor, 
which sooner or later force the polypus through 
the mouth of the womb into the vagina, and may, 
finally result in producing inversion of the uterus 

, — . ———3 

• Colombat on Diseases of Females, page 395 



152 THIRTY YEARS OF FEMALE LIFE. 

as previously stated. In other cases, where the 
pedicle of the tumor is of sufficient length to allow 
of its remaining in the vagina without dragging 
down the upper part of the womb, there is a miti- 
gation of the symptoms for a season, and the poly- 
pus not only ceases to enlarge, but it has happened 
occasionally, that the neck of the womb has con- 
tracted so firmly around the neck of the tumor, as 
to act like a ligature, and the polypus has become 
detached, putting an end to all further trouble ; or 
where the polypus was attached by a very slender 
pedicle, the force of the expulsive pains has sev- 
ered its connexion with the uterine cavity, and ex- 
pelled it. More frequently, however, after having 
reached the vagina, the hemorrhage continues to 
such an extent, that if the tumor be not removed 
by art, death takes place, from a wasting away of 
the vital fluid. When a polypus of the uterus is 
developed about the time for the final cessation, or 
turn of life, it may be neglected for a long time, the 
woman being under the impression that it is the 
change that is working on her, and may be greatly 
surprised to find, after straining at stool, a substance 
force itself through the mouth of the womb, block- 
ing up the vagina, interfering with the operation of 
the bowels and the passing of water. In this con- 
nection. Dr. Gooch remarks, " I have known sever- 
al instances in which patients, after this action, 
have been suddenly seized with retention of urine, 
and on examination, a polypus was found in the 
vagina, compressing the urethra.''* 



THIRTY YEARS OF FEMALE LIFE. 153 

In many cases, during the intermission of the 
hemorrhage, there is a discharge from the vagina, 
like the different forms observed in leucorrhoea, or 
it may resemble the discharge in cancer uteri, ii] 
smell and color. The general health is more oi 
less affected, dyspeptic symptoms supervene, ta 
gether with pain in the back, weight in the pelvis^ 
a dragging, bearing down sensation, pain in the 
loins extending to the groins and thighs, swelling 
of the extremities, emaciation, loss of appetite, 
nausea and vomiting. The symptoms are more or 
less influenced according to the situation of the 
polypus, whether in the womb or attached to the 
mouth or neck of the organ. When the polypus 
is of small size, the patient may experience very 
little inconvenience from it, the symptoms increas- 
ing in severity as the tumor increases in size. The 
color of uterine polypi " varies very much, being 
sometimes nearly white, sometimes flesh color, 
marked by veins,* and sometimes nearly brown.""^ 

Dr. Gooch remarks, in regard to the color of 
one he saw at St. George's Hospital, " it was of a 
pale flesh color, mottled, or rather streaked with 
blue veins, like the round balls of soap at the win- 
dows of the perfumers. "t 

Treatment. — When the polypi are small and 
within reach, they have sometimes been removed 
by caustic applied to them, or if attached by a thin 
pedicle, they may be twisted off with a pair of for- 

• Churchill ou Diseases of Women, page 214. 
t Gooch on Diseases of "Women, page 223. 



154 THIRTY YEARS OF FEMALE LIFE. 

ceps. The usual course, however, is to apply a liga- 
ture around the neck of the tumor, which immedi- 
ately stops the hemorrhage, and in a few days, the 
polypus comes away. The knife is sometimes pre- 
ferred to the ligature, but serious hemorrhage is apt 
to follow its use, which may be difficult to control ; 
besides, in most cases, the patients have already 
lost so much blood before applying for treatment, 
that it is desirable to check this bleeding, as soon 
as possible. In applying the ligature, great care 
should be used not to enclose in the loop any por- 
tion of the uterus, as a want of this. precaution has 
caused great suffering, resulting fatally, if the liga- 
ture is not loosened. After being properly adjust- 
ed, should there no untoward symptoms occur, the 
ligature should be tightened every day or two, until 
the tumor is removed. 

" During the time the ligature is applied, the pa- 
tient must, of course, remain quiet in bed ; the 
bowels must be kept free by eneinata, and if there 
be much pain or sleeplessness, an opiate may be 
given. Injections of tepid water, alum and water, 
or infusion of camomile, should be used each day, 
for some little time after the fall of the polypus. In 
most cases, not a drop of blood is discharged from 
the time the ligature is applied, and with care, the 
patient almost always recovers from the state of 
anemia into which she had fallen, and from its sec- 
ondary consequences."^ 

* Churchill on Diseases of Women, page 225. 



THIRTY YEARS OP FEMALE LIFE. 155 

Whatever method is resorted to in the removal 
of the polypus, it does not grow again. If the tu- 
mor is within the cavity of the womb, and the 
neck not dilated so as to reach the polypus, Prof. 
Simpson recommends introducing sponge-tents into 
the mouth and neck of the womb ; these sponge- 
tents are conical pieces of prepared or compressed 
sponge, which, being introduced, absorb the fluids 
of the parts, and consequently enlarge ; they are 
made of different siifes, and used one after the other, 
until the dilatation is sufficient to reach the tumor. 
To facilitate the operation of placing a ligature 
around the neck of a uterine polypus, different in- 
struments have been devised ; the one in most gen- 
eral use, or with slight modifications, is Dr. Gooch's 
double canula, as it is called, which " consists of 
two silver tubes, each eight inches long, perfectly 
straight, separate from one another, and open at 
both ends. A long ligature, consisting of strong 
whip-cord, is to be passed up the one tube, and 
down the other, so that the middle of the ligature 
passes across, from the upper end of one tube, to 
the upper end of the other, and the two ends of 
the ligature hang out at the lower ends ; the tubes 
are now to be placed side by side, and guided by 
the finger, are to be passed up the vagina, along the 
polypus, till their upper ends reach that part of the 
stalk, around which the ligature is to be applied ; 
and now the tubes are to be separated, and while 
one is fixed, the other is to be passed quite around 
the polypus till it arrives again at its fellow tube, 



156 THIRTY YEARS OF FEMALE LIFE. 

and touches it. It is obvious that a loop of the liga- 
ture will thus encircle the stalk. The two tubes 
are now to be joined, so as as to make them form 
one instrument ; for this purpose, two rings, joined 
by their edges, and just large enough to slip over 
the two tubes, are to be passed up till they reach 
the upper ends of the tubes, which they bind to- 
gether immoveably. Two similar rings, connected 
with the upper by a long rod, are slipped over the 
lower ends of the tubes, so a^to bind them in like 
manner ; thus these tubes, which at the beginning 
of the operation were separate, are now fixed to- 
gether as one instrument. By drawing the ends of 
the ligatures out at the lower external ends of the 
tubes, and then twisting and tying them on a part 
of the instrument which projects from the lower 
rings, the loop around the stalk is thereby tightened, 
and like a silk thread around a wart, causes it to die, 
and fall off."^ 

Should leucorrhoea continue after the removal of 
the polypus, astringent injections up the vagina, 
and other appropriate treatment will be required. 
The general condition of the patient must be taken 
into consideration, and the administration of such 
tonics recommended, as tend to restore a healthy 
tone to the system. The bowels should be attended 
to ; if the patient complain of costiveness, gentle 
aperients will be indicated ; if diarrhoea supervene, 
which is often the case, it should be restrained by 
opium, chalk mixture with catechu, cranesbili, and 
other astringents. 

* Goocb on Diseases of Women, page 233. 



THIRTY YEARS OF FEMALE LIFE. 157 

Mucous Polypi. — These differ from the fibrous 
polypi just described, in being of small size, and at- 
tached to the mouth of the womb, or within the 
neck, but not often found, like the preceding variety, 
attached to the inner surface of the body of the or- 
gan. They vary in size from a pea to that of a kid- 
ney bean, and are attached, in some cases, by a small 
pedicle or stem, at others, by a broad base. They 
are soft, of various colors, from white to deep rose 
red. The symptoms caused by these morbid 
growths, are sometimes of but little importance ; 
most frequently, however, they resemble those pro- 
duced by the large variety, though less severe, and 
are subject to similar treatment ; but as they are 
frequently attached by a broad base, where a liga- 
ture could not very conveniently be applied, their 
removal may be effected by the knife, or other cut- 
ting instrument. The application of caustic to the 
cut surface, when necessary, and the injections of 
astringent preparations up the vagina, as previously 
recommended, will usually be sufficient. They are, 
however, liable to grow again after being removed, 
differing in this respect, particularly, from the large 
or fibrous polypus. 

Fibrous Tumors of the Womb. — These morbid 
growths differ from fibrous polypi in several partic- 
ulars, not only in the manner of their formation, 
but also in the symptoms resulting from their pre- 
sence. A fibrous tumor does not attack the mouth 
or neck of the womb, and is not often attached by 
a pedicle, but is imbedded in the tissues of the or- 



158 THIRTY YEARS OP FEMALE LIFE. 

gan. They are more frequently met with after for- 
ty years of age, than before, yet this may be owing 
to their slow growth, existing, probably, a long time 
before discovered, and the undecided symptoms 
arising from their early formation. The unmarried 
female is as liable to them as those who are married. 
They may be single, or a number of them may be 
clustered together, each surrounded by its own 
covering. 

" These tumors may either be imbedded in the 
uterine parieties, or they may be immediately be- 
hind the serous or mucous membranes ; of course, 
in the latter case, they will project internally or ex- 
ternally, causing a considerable alteration in the -fig- 
ure of the womb, and a diminution in its capacity. It 
is very rarely that they commence near the 
cervix.''^ 

Fibrous Tumors. — These morbid growths are of 
various sizes, weighing in some cases, many pounds, 
of a firm texture, sometimes uneven or nodulated, 
presenting the appearance of several tumors clus- 
tered together. On cutting them open, they are 
found to be composed of dense cellular tissue, of 
grayish structure, sometimes of tendinous substance. 
They point into the cavity of the womb, or outward- 
ly, in some instances, and are then found on the 
outside of the womb ; in this situation, they meet 
with less resistance from the surrounding parts, 
than occurs when they grow into the cavity of the 
womb ; under these circumstances, they sometimes 

* Churchill on Diseases of Women, page 202. 



THIRTY YEARS OF FEMALE LIFE. 159 

attain an enormous size. Whatever their situation, 
the womb is rendered larger and heavier than nat- 
ural, which Avould naturally tend to produce mis- 
placement of the organ. In structure, they vary 
considerably, they are sometimes found soft and 
flesh like, or partaking of the structure of the 
womb ; at others, containing calcareous matter, and 
finally becoming ossified. Although usually solid, 
yet they sometimes assume the cystic formation, 
and when attached to the outer surface of the 
womb, have been mistaken for a cystic tumor of 
the ovary, which has resulted in their being tapped, 
and in some cases large quantities of fluid removed 
from them. "Various theories have been broached 
to explain their formation ; by some they are re- 
garded simply as lesions of nutrition, and by others 
they are considered as a species of concretion 
around a nucleus of coagulated blood or pus."* 

Symptoms. — These will depend upon the size of 
the tumor, their situation, and whether complicated 
or not, with pregnancy. At first there is little 
or no disturbance of the system, indicating their 
presence. Pregnancy may take place, even if the 
tumor is of considerable size, and if the woman 
goes her full time, she may have a difficult labor, 
with great liability to hemorrhage. It often hap- 
pens, however, that abortion comes on about the 
third or fourth month. As the tumor increases in 
size, the symptoms become more marked, there is a 
fullness and weight in the pelvis, a dragging from 

* Churchill on Diseases of Women page 203. 



160 THIETY YEARS OF FEMALE LIFE. 

the loins extending to the groins, cramps, swelling 
and numbness of the lower extremities ; pain in 
the lower part of the back ; the functions of the 
bladder and rectum are interfered with, from the 
pressure of the enlarged womb. The menstrual 
function is more or less affected, even when the 
tumor is small, as in polypus uteri. There is some- 
times an obstruction to the monthly flow for a 
number of months, accompanied with the usual 
symptoms of pregnancy. These occurring in the 
unmarried female, has given rise to the suspicion of 
pregnancy, and not a few have lost a fair name 
and character from being so unfortunate as to have 
a tumor of the womb. The back wall of the uterus 
is said to be the seat of these timoiors more frequently 
than any other portion of the organ ; whatever 
their location, misplacement of the womb is often 
the result, followed by the usual symptoms. This 
circumstance, probably, has been overlooked in 
many cases, and the symptoms arising from the 
misplaced womb attributed to the tumor, when if 
the womb could be righted, and kept in its natural 
place, the inconvenience complained of would dis- 
appear. The womb is sometimes pushed over in 
front, in consequence of the tumor being situated 
on the outside of the organ, blocking up the poster- 
ior portion of the pelvis. 

Treat:ment. — In some cases, the covering of the tu- 
mor becomes absorbed, and it drops into the uterine 
cavity, from whence it is expelled, or if it assume a 
pediculated form, it may be removed by the ligature, 



THIRTY YEARS OF FEMALE LIFE. 161 

knife or by torsion. When the tumor is within 
reach, of moderate size, and the covering thin, the 
outer layer of tissue has been divided by the knife 
or caustic ; when, by proper management, it has 
been shelled out of its position and removed. If 
situated on the external surface of the womb, and 
of large size, filling up the pelvis, and causing great 
inconvenience from the pressure on the bladder, 
and rectum, they may sometimes be pushed up, or 
elevated so high in the pelvis, as to greatly relieve 
the parts. They have also been removed by an in- 
cision through the walls of the abdomen. When 
occurring with pregnancy, and situated in the uter- 
ine cavity, they have sometimes been removed im- 
mediately after the birth of the child. When they 
are not removed, dangerous and often fatal bleedings 
take place, from the tumor imbedded in the uter- 
ine wall preventing contraction. As the probable 
cause of these tumors, in most cases, is due to chron- 
ic inflammation and congestion of the tissues of the 
womb, at some period, joined with a scrofulous habit, 
alterative medicines are indicated, as iodide of po- 
tassium half a grain to a grain, with ten or fifteen 
drops of syrup of iodide of iron, two or three 
times a day, after eating. Bromide of potassium 
has been used with good success, three to five grains, 
which may be increased to eight or ten grains, two 
or three times a day. Sarsaparilla and others of 
this class will be of service, as auxiliaries, in the. 
treatment. Also mucurial ointment, or the iodine 
ointment, well rubbed in over the uterine region, 



162 THIRTY YEARS OF FEMALE LIFE. 

has had a good effect in many cases. The iodine 
ointment has also been applied to the mouth of the 
womb. An ointment of bromide of potassium has 
been used in the same way. General or local bleed- 
ing may be indicated in some cases, also hip or sitz 
baths, and blisters. The bowels should be kept open 
with mild aperients, and the general health receive 
special attention. As it often happens that these 
fibrous tumors of the womb are not developed un- 
til late in life, and are frequently of slow growth, 
the patient will often do well under a palliative 
treatment. 



CHAPTER XVIII. 

OVARIAN TUMORS — OVARIAN DROPSY. 

The ovaries are often affected with abnormal 
growths of various kinds, resulting in more or less 
inconvenience, suffering and death, according to the 
rapidity and nature of the enlargement, whether 
fluid or of a solid texture, non-malignant or malig- 
nant. An ovarian tumor, containing a fluid, is re- 
cognized by the term, ovarian dropsy. The fluid 
may be contained in a simple cyst, or there may be 
a number of simple cysts, connected together by 
cellular tissue, forming an uneven lobulated tumor; 
they frequently attain an immense size, distending 
the abdomen to its utmost capacity. Ovarian drop- 



THIRTY YEARS OP FEMALE LIFE. 163 

gy is usually of slow growth, most frequently met 
with between thirty and forty years of age ; cases 
are recorded, however, of its occuring before the 
twentieth year, and after menstruation has finally 
ceased. Dropsy of the ovary consists in an enlarge- 
ment of one or more ovarian vesicles, which assume 
the cystic formation, and are sometimes divided into 
simple cysts, and multilocula, or many cysts ; they 
have a common origin, yet are said to differ greatly 
in their early formation, the multilocula, not assum- 
ing the fluid consistence until they have attained 
considerable size, being at first solid. The simple 
cyst, containing a fluid from the first. During the 
thirty years of menstrual life, at each monthly peri- 
od, as previously stated, the ovaries become more 
or less engorged ; this process results in disen- 
gaging a vesicle, of which the ovaries are princi- 
pally composed, which, after passing through the 
fallopian tubes into the womb, the phenomena of 
menstruation is established. As the ovaries are 
frequently subject to chronic inflammation, we have 
here the starting point of the disease under consi- 
deration ; for, the eff'ect of inflammation is to pro- 
duce a thickening of the tissues. In this way, the 
investing membrane of the ovary becomes so dense, 
that the escape of a vesicle is prevented, the nor- 
mal action of the ovary, or a portion of it, is 
changed to abnormal, a cyst is formed, which en- 
larges more or less, until it is recognized as ovarian 
dropsy. One vesicle, or a number of them, may be 
thus aflfected, giving rise to the multilocula or sim- 



164 THIRTY YEARS OF FEMALE LIFE. 

pie cyst. The disease is not often confined to one 
vesicle ; usually several of them enlarge at the 
same time ; at first they are of a globular form, but 
as they increase in size, by pressing upon one another, 
become flattened, the tissue separating them bursts, 
and two or more cysts are thus converted into one. 
By this process, it often happens that a multilocula 
tumor is converted into a simple cyst. In some 
cases, where there is an enlargement of several 
vesicles, one of them greatly exceeds the others 
in size, we therefore find them in diff'erent stages of 
development. 

" The true composite cysts contain in their cavi- 
ties, a liquid, which is either purely serous, or min- 
gled with a little blood, the result of the rupture of 
the vessels in their interior. In rare cases, but usu- 
ally in a few isolated cavities only, we find in cysts 
of this character, a mass of fat, of hairs, of cartilage, 
bones or teeth. We should add here, that in such 
tumors, the contents ordinarily vary in difi'erent 
compartments, and it is not rare to meet in a single 
multiple cyst, all the various substances which we 
have mentioned. The fatty accumulations which are 
so often found in these organs, are caused by the 
excessive development of the layer of cells, of 
pavement epithelium cells, which is frequently 
found on the internal surface of cysts. The fat 
which forms them, is most often liquid, of an orange 
or bronze color ; sometimes, however, it forms clots 
of solid, yellow fat, ordinarily containing a consider- 
able quantity of cholesterine. The hair, which is 



THIRTY YEARS OP FEMALE LIFE. 165 

often found in these fatty cysts, is variously colored 
and entangled, so as to form cushions of greater or 
less thickness. They have their roots in the wall of 
the cyst, provided with sebaceous follicles, or in the 
layer of the epidermis, which, as we have said, 
sometimes covers this wall. The teeth, which are 
sometimes observed in certain isolated cavities of 
the tumors in question, are developed in the interior 
of the wall of the cyst, in the usual dental sac, and 
sometimes their abundance is such that cavities are 
seen filled with teeth, loose and free from adhesions. 
The bony material proceeds from the ossification of 
the cellular tissue of the walls of the cysts ; they 
are sometimes long bones, sometimes flat bones, but 
they have no resemblance to any bones of the 
skeleton."^ 

" The quantity of fluid contained in a dropsical 
ovary, varies very much in difi'erent specimens. At 
first, the morbid accumulation of serosity is scarce- 
ly perceptible ; but, in a more advanced stage, it 
may be very considerable. Morand had an ovarian 
cyst, which held ten pints, and he mentions that Dr. 
Buret, of Vitry-lg-Pran9aise, reported to the Acade- 
my, in 1740, the history of a case of ovarian dropsy, 
in which the cyst held fifty pints ; it had distended 
the abdomen so much, that the woman was obliged 
to tie her petticoat four finger breadths below the 
axilla. In fine, according to Munro, Wepfer, and 
other authors, the weight of the serum has been 

*Scanzoni'3 Diseases cf Females, page 412. 



166 THIRTY YEARS OF FEMALE LIFE. 

known to amount to a hundred and ten and a hund- 
red and twenty pounds."^ 

Dr. Meigs mentions an immense ovarian cyst, 
which he opened, and acording to his opinion con- 
tained over a thousand ounces of fluid.t 

Ovarian dropsy attacks the right ovary more fre 
quently than the left, and when of long standing, 
both ovaries are usually affected. If only one ova- 
ry is diseased, menstruation is not necessarily inter- 
rupted, but when the disease attacks both ovaries, 
there is suppression of the menses. 

Symptoms. — In the early stage of ovarian dropsy 
the indications of the disease are very obscure, and 
being of slow growth usually, it may exist a long 
time before the attention of the patient is directed 
to it, and even after considerable enlargement of 
the abdomen takes place, the symptoms simulate 
pregnancy so much, that women sometimes believe 
that they are pregnant, and in some cases have made 
preparations for their anticipated confinement. 

" In a case detailed by Vater, the patient had 
symptoms of pregnancy, secreted milk, and even 
thought she felt motion. The belly continued 
swelled, and she had bad health for three years and 
a half, when she died. The abdomen contained 
much water, and the right ovarium was found to be 
as large as a man's head, containing capsules, filled 
with purulent looking matter. The uterus was 

*Colombat on Females » page 425. 

f Meigs' Diseases of Women, page 355. 



THIRTY YEARS OF FEMALE LIFE. 167 

healthy, but prolapsed, and the ureter was disten- 
ded from pressure/'^ 

In some cases, the patient complains of pain in 
the region of the ovary, with tenderness on being 
pressed, a feeling of weight in the pelvis, a drag- 
ging sensation in the loins, and pain extending to 
the groins and thighs, with numbness and some- 
times swelling of the thigh and leg, pressure on 
the rectum and bladder, frequent inclination to pass 
water ; the bowels are often constipated, the en- 
larged ovary produces more or less misplacement 
of the womb ; the menstrual function is sometimes 
affected, being excessive, painful, or suppressed. 
As the tumor enlarges and forces itself up out of 
the pelvis, there is sometimes a mitigation of some 
of the symptoms, from the organs within the pelvis 
being relieved from the immediate pressure of the 
enlarged ovary. In some cases, the first indica- 
tion the patient has of the disease, she finds that 
one side, just above the groin, is fuller than the 
other side, and by a closer examination, she finds a 
tumor there. "When the cyst has become large 
enough to push the bowels and the stomach up- 
wards against the diaphram, and to thrust the latter 
upwards within the confines of the thorax, the 
powers of digestion are interfered with, and res- 
piration is embarrassed. "t 

" The peritoneal envelope of the tumor frequent- 
ly becomes the seat of an acute or chronic inflam- 

* Churchill on Diseases of Women, page 365. 
t Colombat on Diseases of Femaleg, page, 247. 



168 THIRTY YEARS OF FEMALE LIFE* 

mation, which often communicates to other portions 
of the peritoneum, and is the cause of painful, in- 
tense and reiterated paroxysms. At this stage of 
the disease, new disorders are observed, affecting the 
bladder ; because this organ, being indirectly con- 
nected with the tumor by the agency of the peri- 
toneum and the uterus, is constantly drawn higher, 
a displacement which, by itself, suffices to render 
more frequent the desire of micturition. The com- 
pression which the tumor exerts upon the bladder 
from before backward, also contributes to prevent 
the dilatation of this organ in the indicated direc- 
tion. Sometimes the compression of the inferior 
portion of the bladder has been seen preventing 
the flow of the urine through the ureters. Hence, 
it occasions, frequently, a considerable dilatation of 
these organs and the calix."* 

Treatment. — The treatment of ovarian dropsy, 
as in other tumors of these organs, offers little en- 
couragement as to its ultimate success,, yet, if we 
rarely cure the disease, many cases are often ben- 
efited or relieved, and by staying the progress of the 
abnormal growth, it sometimes happens that nature 
accomplishes what art has failed to produce. As 
most of the abnormal growths of the ovaries occur 
in patients of a scrofulous habit ; during the early 
stage of the disease an alterative treatment has 
sometimes produced favorable results. Not so much 
by any specific action they may have on the tumor, 
but, by changing the secretions. For this purpose, 

*Scanzoni on Diseases of Females, page 426. 



THIRTY YEARS OP FEMALE LIFE. 1G9 

the preparations most relied on are iodine, iodide of 
potassium, iodide of iron, brojnide of potassimn, 
sarsaparilla and others of this class ; also salt water 
bathing or sponging ; frictions over the region of 
the tumor with mercurial or iodine ointment, and 
blisters and leeches. Electricity has been favorably 
mentioned in this complaint ; that this agent has 
produced beneficial results in abnormal growths of 
different portions of the organism, there is no doubt, 
and were it resorted to earlier, instead of waiting 
until all other means have failed, the probability is 
that a much more favorable report might be ren- 
dered of this subtile agent in ovarian tumors. The 
bowels should be kept in a soluble condition by 
saline laxatives, and a nutritious, unstimulating diet 
recommended ; the condition of the bladder should 
be attended to, if there is retention of urine the 
catheter should be used. If adhesions have not ta- 
ken place, the tumor can sometimes be pushed up 
above the brim of the pelvis, to the great relief of 
the patient. When symptoms of general dropsy 
supervene, digitalis, squills and other diuretics have 
been recommended. The internal administration 
of the different preparations of mercury do not find 
much favor with most authors on this subject, as 
patients of a strumus habit do not often tolerate 
this drug. When the tumor has become so large 
as to distend the abdominal walls, a properly ad- 
justed bandage when the patient is on her feet, will 
often give relief, also tepid hip baths and foraenta'- 
tions to the bowels ; if inflammatory symptoms ar^ 



170 THIRTY YEARS OF FEMALE LIFE. 

observed, local blood-letting by leeches, or bleeding 
from the arm has been recommended. Dr Hamil- 
ton states, that after sixteen years trial, he has 
^' succeeded in a number of cases, in curing or re- 
tarding the disease, by the simple means above al- 
luded to, viz. from compression of the abdomen, 
percussion, the use of the warm bath, and a pro- 
tracted course of the muriate of lime, together with 
the ordinary means for promoting general health. ^^^ 

The ovarian cyst sometimes bursts, the fluid being 
poured out into the abdominal cavity, resulting gen- 
erally in fatal peritonetis, yet the effused fluid is oc- 
casionally absorbed, and the patients recover. In 
some cases, the ovarian cyst has been known to 
form an opening into the small intestines, rectum, 
bladder, or vagina ; the contents escaping through 
these outlets, resulting, sometimes, in a cure of the 
malady. In some cases, the contents of the tumor 
finds its way into the stomach, and the patients 
vomit up large quantities of it. In regard to tap- 
ping, for the cure of ovarian dropsy, the result of 
the operation depends on the character of the tu- 
mor, whether simple, or composed of many cysts^ 
and the nature of the accumulation. The condition 
of the patient, also, has much to do with the suc- 
cess or failure of the operation. 

A simple cyst, containing a serous fluid, may be 
evacuated by tapping, resulting, sometimes in a 
cure of the complaint ; more frequently, however, 
it has to be repeated. If the tumor is composed of 

* Churchill on Diseases of Women, page 370. 



THIRTY YEARS OF FEMALE LIFE. 171 

a number of cysts, the result of the operation is not 
so favorable as in simple cysts ; for the tumor is di- 
vided into compartments, having no connection, one 
with another : hence, if the contents of one of the 
cysts should be removed by tapping, the others are 
not relieved by it, each requiring a thrust of the 
trocar, to liberate the fluid which they contain. 
Having punctured one of the cysts, and introduced 
the canula, others can sometimes be opened, as in 
the case mentioned by Dr. Cole, of Boston, by in- 
troducing the trocar, without removing the canula 
from the first operation. The contents of the dif- 
ferent cysts are often of various consistence, some- 
times it is so thick that little, or none, escapes 
through the canula, when introduced into the tumor; 
in such a case, no benefit could be expected from 
the operation. When performed under favorable 
circumstances, tapping often results in but tempo- 
rary relief, as the cyst is apt to refill again in a 
short time, which soon makes another operation 
necessary. 

" Although women do live, now and then, to un- 
dergo these frequent tappings, yet they more gen- 
erally sink ; and hence, in ordinary practice, the 
longer the first tapping can be delayed, the better ; 
for there is nothing more unwise than to ground 
your general practice upon the exception to the 
rule, though the error is not unfrequently committed. 
Tapping, after all, is an unsatisfactory remedy ; in 
scirrho-dropsy it is dangerous ; in dropsy, with ma- 
ny cysts, it is of partial relief ; when the encysted 



172 THIRTY YEARS OF FEMALE LIFE. 

accumulation is viscid, it is of no effect ; an even 
in cases the most favorable, tapping exposes the pa- 
tient to inflammations, adhesions, suppurations, ex- 
haustions, repetitions, and death. ''"^ 

In order to prevent the bad effect often resulting 
from a large cyst being emptied at once of its con- 
tents, a plan has been adopted of drawing off por- 
tions of it at a time ; this mode may be more judi- 
cious than that of allowing a number of gallons of 
fluid to escape immediately, yet, fatal results often 
follow, even in this cautious manner of operating. 

Before proceeding to the operation of tapping, 
several important particulars should be clearly 
made out, as serious mistakes have occurred by 
confounding ovarian dropsy with other abnormal 
growths of the ovaries, with dropsy of the perito- 
neum, with misplacements and tumors of the womb, 
with pregnancy, and a distended bladder, from a 
large accumulation of urine. 

^'A distended bladder has been mistaken for 
ovarian dropsy ; nay, the uterus itself has been tap- 
ped, when the womb was pregnant.'^f 

In regard to the instrument for removing the 
fluid contained in the cyst. Dr. Churchill remarks : 
" A flat trocar and canula appear to occasion the 
least pain, and it should be plunged suflSciently 
deep, to insure its traversing the parieties of the 
cyst. After the operation, a broad binder should be 
applied tightly around the abdomen.^^J 

♦ Blundell on Diseases of Women, page 113. 

JBlundell on Diseases of Women, page 111. , 

ChurctiiU on Diseases of Women, page 372. 



THIRTY YEARS OF FEMALE LIFE. 173 

Two modes of puncturing the cyst have been 
practised : — first, through the abdominal walls ; 
second, through the upper part of the vagina. The 
spot usually selected for the first, is on, or near, the 
median line, from the navel to the symphasis pubis, 
as low down as may be, and avoid wounding the 
bladder, and as a precaution against such an acci" 
dent, the catheter should be introduced, and the 
urine drawn off. Puncturing the tumor through 
the upper portion of the vagina, has one advantage, 
at least, over the previous method, which is that of 
reaching the most depending part of the cyst. 
This may be accomplished when the tumor is of a 
certain size, but when, from its large dimensions, it 
is elevated above the brim of the pelvis, it cannot be 
safely tapped from the vagina. It has been recom- 
mended, after evacuating the cyst, to inject some 
irritating fluid, as iodine, and iodide of potassium 
and water, of different strengths, into the sack, in 
order to set up adhesive inflammation, with the in- 
tention of producing a radical cure of the malady. 
But this mode of treating ovarian dropsy has sel- 
dom resulted favorably. In regard to this subject, 
Scanzoni remarks : — " It results from all that we 
have said upon the subject of injections, that the 
dangers which this method presents are not com- 
pensated by sufiicient advantages. Consequently, 
we shall do better to set it entirely aside, especially 
as many authors have demonstrated that it was not 
so sure as we have been told."^ 

♦ Scanzoni on Diseases of Females, oafire 467. 



174 THIRTY YEARS OF FEMALE LIFE. 

When the contents of the cyst is so thick that 
it cannot escape through the canula, an incision has 
been made, more or less extensive, into the cavity 
of the tumor. Dr. Burns says of this mode of 
practice : — ^' It has been attempted to produce a 
radical cure, by laying open the tumor, evacuating 
the matter, and preventing the wound from healing, 
by which a fistulous sore is produced ; or by intro- 
ducing a tent, or throwing in a stimulating injection. 
Some of these methods have, it is true, been suc- 
cessful, but occasionally they have been fatal ; and 
in no case which I have seen, have they been at- 
tended with benefit.''^ 

In regard to the propriety of removing the dis- 
eased ovary, great diversity of opinion exists 
amongst medical authors. The operation is approv- 
ed of by men of great scientific attainments, and 
opposed by others of equal note. Scanzoni says, 
in regard to the negative side of the question, 
" we consider ovariotomy a surgical temerity ; but if 
it succeeds, the patient, being otherwise completely 
incurable, speaks of it with great thankfulness, and 
the public is astonished. It is a rash operation, for 
from numerous observations collected up to this 
time, the physician can never predict the issue 
with the same certainty which guides him in all 
the other important chirurgical operations, for ex- 
perience has demonstrated that the extirpation of 
ovaries, performed by the most skillful operators? 
without any accident happening to disturb the 

* Burns' Midwifery, page 117. 



THIRTY YEARS OF FEMALE LIFE. 175 

operation, and with the best conditions for obtain- 
ing complete success, have caused the death of pa- 
tients a few days and even a few hours after the 
close of the operation."* 

Scanzoni also gives the opinion of the celebra- 
ted Velpeau, as he expressed himself in 1857, " I 
disclaim extirpation ; to legitimatize it, we must 
threaten life, and to be rationally practicable, it re- 
quires that the cyst should be of small size. Now, 
in this state, life may continue for many long years. 
We do not envy, then, the ovariotomy of our broth- 
ers in America. French surgery is to-day in an ex- 
cellent way. Though at the same time very bold 
and very prudent, it ought to renounce a venture- 
some operation. Before it can be admitted, it is 
necessary, in a word, that the remedy should be 
less dangerous than the disease. "t 

Colombat also remarks, " we shall conclude by 
saying, that inasmuch as ovarian tumors are rare- 
ly composed of a single cyst, since they are often, 
on the contrary, multilobed, and adherent at sever- 
al points ; as they contain, in the greater number 
of cases something more than serosity ; and as, 
moreover, the dropsy which almost always ends 
with attacking both ovaries, is not unfrequently 
complicated with other lesions, which render the 
diagnosis obscure and the prognosis unfavorable, 
we are tempted to say, with the celebrated Hunter, 
that patients are often more likely to prolong their 

* Scanzoni on Diseases of Females, page 471. 
t Scanzoni on Diseases of Females, page 470. 



176 THIRTY YEARS OF FEMALE LIFE. 

existence, if no attempt is made to deliver them of 
their disease.""^ 

These several objections to the operation, refer 
principally to cases that would be considered un- 
suitable for the operation by those in favor of it, 
for it is a point of great importance, before com- 
mencing the operation, not only to consider the 
general health of the patient, but by a careful ex- 
amination of the tumor, to be well convinced that 
it is not complicated with malignant disease that it 
has not formed extensive adhesions with the in- 
ternal viscera, and several other important particu- 
lars. That the operation sometimes results in death, 
even when performed under favorable circumstan- 
ces, cannot be questioned ; we see the same result 
from the amputation of a limb, when there was no 
reason to anticipate anything but a favorable ter- 
mination. Many women have died from puerperal 
peritonetis, that presented no indications of the 
disease at their confinement. That the result of 
the operation cannot be anticipated, is no disparage- 
ment, as the same is true of other operations, to a 
great extent. In regard to the fatality of the oper- 
ation, according to the table prepared by Dr. Atlee, 
published in the American Journal of Medical 
Sciences for April, 1845, of one hundred and sev- 
enty-nine cases operated on for ovarian dropsy, 
one hundred and twenty recovered, and fifty-nine 
died. From a table of one hundred and twenty- 
three cases of ovarian dropsy not operated on, we 

* Colombat on Diseases ©f Females, page 436. 



THIRTY YEARS OF FEMALE LIFE. 177 

find that ninety of this number " terminated fatally 
within five years, and more than one third this 
number within one year from the observed com- 
mencement of the disease/'* 

As we have previously shown that a spontaneous 
cure sometimes takes place, and that the disease 
may remain stationary or increase but little, during 
a period of many years, the great liability to a fatal 
termination, in all cases operated on, should be 
weighed against the chances in favor of the patient 
if let alone. 

Non-Malignant Tumors of the Ovaries. — The 
ovaries are sometimes the seat of fibrous tumors, 
which may be imbedded in the substance of the 
ovary, or attached to its surface, and like fibrous for- 
mations of the womb, which they closely resemble, 
may attain considerable size ; they have been known 
to weigh forty pounds and upwards. The general 
health is not usually afiected by them, until by their 
size, the circulation in the pelvic vessels, and the 
functions of the bladder and rectum are impeded. 
They are of slow growth, and often after attaining a 
certain size, remain stationary for life. The symptoms 
to which they give rise are principally mechanical, 
as they frequently cause more or less misplacement 
of the womb, often crowding it over to one side or 
by pressing upon the rectum or bladder, the patient 
will experience those sensations previously men- 
tioned under the head of misplacement of the 
womb. In regard to the treatment, little benefit 

*West on Diseases of Woraeiij page 402. 



178 THIRTY YEARS OF FEMALE LIFE. 

results from any course, more than to remove the 
pressure upon the bladder and rectum, by pushing 
the tumor up out of the way of these organs, keep- 
ing the bowels in a soluble condition by saline 
aperients, and preventing any undue accumulation 
of urine in the bladder, and attending to the gener- 
al health ; an alterative course of treatment has 
been recommended, together with frictions over 
the region of the tumor with the mercurial and 
iodine ointment, but the success has rarely compen- 
sated for the trouble. The ovaries are also affec- 
ted with other non-malignant growths, as the carti- 
laginous tumors, osseous or bony ttjjnors, petrous 
or stony tumors, tubercula tumors, a species of de- 
generation of pale yellowish color, which sometimes 
becomes soft, resembling pus ; and melanic tumors, 
consisting of a hard black substance. 

Malignant Tumors of the Ovary. — Cancer of 
the ovary, is said to be of more frequent occurrence 
than cancer of the breasts, and nearly as frequent 
as uterine cancer. The tumor often attains a very 
large size, weighing, in some instances, fifty pounds 
and more. Cancer of the ovaries, like cancer of 
the womb, presents itself under different forms. 
Scirrhus, and encephaloid or medullary cancer, are 
the two forms usually referred to by medical writers. 
In either case, it is an uneven, lobulated tumor. 

In speaking of the two forms of ovarian cancer, 
Dr. Seymour says, the first " consists of numerous 
cysts, with more or less fluid contents ; sometimes 
with bony or earthy matter contained in them; 



THIRTY YEARS OF FEMALE LIFE. 179 

often a fatty secretion, resembling lard ; sometimes 
penetrated with long, fine hair, without bulbs ; 
but more frequently filled with albuminous secre- 
tions of varying tenacity and color. Sometimes 
these secretions resemble gruel in appearance ; 
there is often matter like soot mixed with the fluid. 
At other times, the secretion is of the color of ma- 
hogany, from admixture of blood ; and not unfre- 
quently, the liquor evacuated from one of these cysts 
by the trocar, resembles in consistence and color, 
the medicine well known under the name of Grif- 
fith's Mixture. Secondly, a single large cyst springs 
from the ovarium, and contains within it, tumors 
varying from the size of a pin's head to that of an 
orange. Sometimes the great portion of the parie- 
ties of the cyst consists of tumors, growing between 
►.the external and internal, or secreting coat ; the in- 
terior of the cyst having the tumors projected into 
it, being filled with fluid, secreted from the serous 
lining. The tumors, when cut into, present a semi- 
fluid, gelatinous substance, with white bands run- 
ning through it ; between which bands are smaller 
cysts, containing the same viscid, glue-like matter.''* 

The scirrhus form is a hard engorgement, often 
remaining in this state for many years, or for life. 
The encephaloid cancer differs from the preceding 
in texture, in development, and termination. 

" Sometimes the ovarium is affected with enceph- 
aloid disease, or is converted into a large irregular 
shaped mass of cysts and tumors, the section of 

♦Seymour on Diseases of the Ovaria, paga 60. 



180 THIRTY YEARS OF FEMALE LIFE. 

which presents all the characters of hematoid fun- 
gus. This fatal affection usually runs its course 
with great rapidity, and soon after its commence- 
ment, the constitution of the patient is much more 
affected, than in the organic diseases of the ovaria, 
which have already been described.'^* 

The symptoms of Cancer of the Ovary are at 
first vague and uncertain. It may exist a long time 
before its real nature is discovered. As the tumor 
becomes developed, there is pain and numbness of 
the hip, dragging from the loins, pressure upon the 
bladder and rectum, and other symptoms, as in 
cancer of the womb. The disease, whether uterine 
or ovarian, observes pretty much the same changes 
and peculiarities. The scirrhus form remaining 
stationary a long time, or increasing very slowly, 
and in the encephaloid form, attaining a large size , 
in a short time, accompanied with all the distressing 
characteristics of the disease. The treatment, also, 
of ovarian cancer differs only in some minor points 
from uterine cancer. In either case, under the most 
judicious treatment, the hopes of ultimate success 
are very small. It has been proposed to remove the 
cancerous ovary, but there are few who would have 
the temerity to undertake the operation. 

*L€e, Cyclopedia of Practical Medicine, Art. Diseases of the Ovaria. 



THIBTY TEARS OP FEMALE LIFE. 181 



CHAPTER XIX. 

PROLAPSE, OR FALLING OF THE VAGINA. 

This misplacement of the front passage is some- 
times divided into three forms. First, falling of the 
anterior wall ; second, falling of the posterior wall; 
and third, where the entire circumference of the 
vagina comes down, In either case, two conditions 
are necessary to produce the misplacement, namely : 
weakness of the vaginal tissue, and a sufficient 
force from above to overcome the normal condition 
of the parts. It is usually complicated with mis- 
placement of the bladder, rectum, or womb, and oc- 
curs most frequently with women who have had 
children. It may occur in other cases, independent 
of child-birth. The first variety of this misplace- 
ment consists in the falling of the front portion of 
the vagina, presenting the form of a tumor, filling 
up the entrance to the front passage, or pressing en- 
tirely out of the passage ; when examined by the 
finger, it will be found soft and yielding, with fluctu- 
ation, unless the bladder has been completely emp- 
tied of its contents, which is not easily accomplished. 
This tumor is the prolapsed anterior wall of the va- 
gina, and the posterior portion of the bladder ; it is 
therefore, a prolapse of the bladder as well. The 



182 THIRTY YEARS OP FEMALE LIFE. 

second form of vaginal misplacement consists in a 
bulging forward and downward of the posterior 
part of the vaginal wall, with a portion of the rec- 
tum, which forms a tumor that may make its appear- 
ance externally. If examined by the finger, the 
fluctuation observed in the preceding variety is ab- 
sent, but the pouch or tumor is more or less dis- 
tended with the contents of the rectum. The third 
form of vaginal misplacement may occur without 
implicating the bladder or rectum. It is then sim- 
ply a settling down of the front passage, appearing 
at the entrance in a fold, or passing through, form- 
ing a tumor externally ; in most cases, however, of 
this variety, the bladder, or rectum, or both, are 
also prolapsed. "Noel relates a case where the 
prolapse reached down to the knees. ""^ 

The symptoms of these several species of mis- 
placement have some points in common, as weight 
and fullness in the vagina, pressure and bearing 
down, aggravated by standing or walking, and when 
the prolapsed portion protrudes through the exter- 
nal opening, it becomes irritated, if it remains long 
in this exposed condition. 

" When the prolapsus is neither very considera- 
ble, nor of very long standing, the part of the vagi- 
na which is exposed does not ordinarily present, in 
relation to its color, and to the state of the mucous 
membrane, any notable alteration, still it is not rare, 
especially after exposure to certain injurious influ- 

* Churchill on Diseases of Women, page 94. 



THIRTY YEARS OF FEMALE LIFE. 183 

ences, that its surface is reddened, excoriated, or 
even covered with deep ulcerations. 

" In more voluminous prolapsus, most often com- 
plicated with a falling of the uterus, the tumors re- 
main, during a long time, exposed to the action of 
the atmosphere, and to the friction of the internal 
surface of the thighs ; it is constantly moistened by 
the urine, and its surface is soon covered with a 
thick layer of pavement epithelium, the mucous se- 
cretion completely ceases, or dries rapidly, in such 
a manner, that the walls of the vagina are no longer 
smooth, and gliding to the touch, but rough and 
dry, and often the seat of numerous and extended 
ulcerations.'^^ 

In prolapse of the anterior wall of the vagina, 
the patient complains of a dragging sensation from 
the navel extending towards the groins, with fre- 
quent inclination to pass water, and after voiding a 
small quantity, the stream stops ; in some cases the 
patient is obliged to push up the tumor with her 
finger, before she can empty the bladder of the 
urine it contains. In prolapse of the posterior wall 
of the vagina, the bladder is not usually affected, 
but there is more or less difficulty in having an op- 
eration of the bowels. When the entire circum- 
ference of the vagina comes down, a falling of the 
womb ensues, to a greater or less extent, with the 
usual symptoms attending this misplacement, and 
if, as sometimes happens, there is a prolapse of the 

♦Scanzonl on Diseases of Females, page 498. 



184 THIRTY YEARS OP FEMALE LIFE. 

bladder and rectum at the same time, the distress 
is greatly aggravated. Leucorrhoea is often present 
in either case, and sometimes the menstrual func- 
tion is affected. 

Treatment. — The parts are to be replaced in the 
natural situation, and kept there by some kind of 
pessary, if astringent injections up the front passage 
and cold hip baths will not have the desired effect. 
The bowels should be kept in a soluble condition, by 
injections or gentle aperients. The bladder should 
be often relieved by the catheter, if necessary, as 
the urine, if allowed to accumulate, will keep up 
the misplacement. If the general health has suf- 
fered from the abnormal condition of the parts, 
the treatment will be indicated by the condition of 
the patient. In some cases, where the parts were 
with difficulty retained in their natural situation, 
an operation has been performed, producing a per- 
manent contraction of the vagina. It consists in 
removing portions of the vaginal wall, by some 
cutting instrument, bringing the edges of the wound 
together and keeping them thus until they unite ; 
in this way, the passage is contracted so that a pro- 
lapse could not occur. It is needless to remark that 
an operation of this kind would be admisible only 
in such cases as had passed the child-bearing age, 
or were not liable to become pregnant, as the vagina 
thus contracted would be lacerated before delivery 
could be accomplished. 

TiBiORS OF THE Vagina. — Morbid growths of the 
vagina are occasionally met with, of the same char- 



THIRTY YEARS OF FEMALE LIFE. 185 

acter as those attached to the womb. They vary 
in size according to the nature of the tumor. Sex- 
ual intercourse is sometimes rendered painful from 
them ; they are also the cause of leucorrhoea, and 
in some cases hemorrhage. They sometimes produce 
a prolapse of the vagina, and cause more or less 
inconvenience and suffering, according to their loca- 
tion and size. The treatment applicable to similar 
tumors of the neck of the womb, is indicated in 
these tumors of the vagina. 

Cancer of the Vagina. — The vagina is rarely 
affected with cancer, except in cancer uteri, the 
disease spreading from the womb to the vagina, and 
attacking that portion in closest proximity to the 
diseased portion of the womb. The symptoms and 
treatment correspond, to a certain extent, with a 
similar disease of the womb. 

Vascular Tumor of the Urethra. — This is a 
small tumor situated at the orifice of the urethra, of 
a bright red color, the size of half a pea, and in 
some cases not larger than the head of a pin, at 
other times much larger, very tender to the touch, 
accompanied with almost constant pain, with fre- 
quent desire to pass water, which is attended with 
intense burning and smarting ; the pain is also in- 
creased by sexual intercourse, and by walking ; 
very often there is a puriform discharge from the 
urethra. Although usually situated at the orifice, 
in some cases the tumor is attached to some por- 
tion of the water passage, a short distance from 



186 THIRTY YEARS OF FEMALE LIFE. 

the orifice, and cannot be brought into view until 
the urethra is dilated. In some cases, there are 
several of them clustered around the orifice, or just 
within the passage. If not removed, they some- 
times attain the size of a bean or larger. The best 
method of getting rid of these troublesome excres- 
ences, is to snip them off with a pair of curved 
scissors, care being taken to remove all the growth. 
The hemorrhage, which is sometimes considerable, 
can be restrained by touching the cut surface with 
nitrate of silver, or nitric acid. Some recommend 
removing them by ligature, but this mode has 
no particular advantage to recommend it. When 
very small, they have been cured by touching them 
every three or four days with nitrate of silver, and 
other caustics, but even when ever so small, excis- 
ion is preferable to any other mode ; and if the 
nitrate of silver is then applied freely to their base, 
they will rarely grow again. If, after the operation, 
the parts should become inflamed, apply lead wash 
and other cooling lotions. 



THIBTY YEARB OF FEMALE LIFE. 187 



CHAPTER XX. 

PRURITUS, OR ITCHING OF THE VULYA. 

This is a burning, smarting, stinging sensation, or 
an intense itching of the privates. It may affect 
the external parts, the vagina, or the neck of the 
womb. To relieve the intolerable itching, the pa- 
tient rubs or scratches herself to such a degree, 
that the skin becomes excoriated, which aggravates 
the malady. It usually occurs during pregnancy, 
but is not confined to women in this condition, as it 
sometimes affects young females, at the com- 
mencement of menstruation, and is also observed at 
the turn of life, and sometimes afflicts elderly fe- 
males, who have long passed the second critical 
period. 

" It is sometimes an unpleasant sense of creeping 
or formication ; at other times, a feeling of smarting, 
while in other cases, the positive itching is so dis- 
tressing as to be almost unbearable. Warmth al- 
ways aggravates it, and with some persons, it suffi- 
ces to come into a warm room in order to experience 
an attack of it; while in the case of most patients, 
the nights are in a great measure sleepless, because 
to lie down in bed is at once a signal for the com- 
mencement of the itching. Cold, for a moment, 
eases it, but this relief is but momentary, and pa- 



188 THIRTY YEARS OP FEMALE LIFE. 

tients are driven to scratch and rub themselves, in 
order to obtain a sort of relief, which consists in a 
substitution of a burmng, smarting sensation for 
the less tolerable itching. This, however, not only 
does no real good, but the very rubbing of the parts 
both aggravates the patient's condition, and also 
helps to produce, and to keep up, a state of morbid 
sexual excitement, which, in some of these cases, 
constitutes by no means the least of her sufferings.''^ 
If the parts are examined, they are sometimes 
found in a healthy condition, but very often, there is 
more or less inflammation observed, and the parts 
are found studded with little red points, or covered 
with an eruption resembling aptha or thrush, which 
sojnetimes extends up the vagina to the neck of the 
womb. Dr. Dewees mentions a case in this wise :— 
" A lady, whose husband was more notorious for his 
gallantries than his domestic virtues, was attacked 
in the incipient stage of pregnancy, with an intoler- 
able itching in the pudendum, and even within the 
OS externum, along the vagina. Suspecting she 
was infected by a venereal affection, we were sent 
for, and she giving such an account of her feelings, 
as to make us think it might truly be the case, we 
proposed an examination of the parts, which was 
finally acceded to. Upon separating the labia, the 
whole face of the vulva, the os externum, and the 
vagina, as far as it could be viewed, was covered 
with an incrustation of apthse. We assured our pa- 
tient that her complaint was not as she had ex- 

*West on Diseases of Women, page 480. 



THIRTY YEARS OP FEMALE LIFE. 189 

pectedjbut one we hoped we could quickly remove. 
We accordingly ordered a strong solution of borax 
in water, and requested her to wash herself four or 
five times a day with it, as well as to throw some of 
it up the vagina at the same time ; she did so, and 
was perfectly well in twenty-four hours."* 

It sometimes happens, that a female, affected with 
this malady, communicates a similar disease to her 
husband. 

" We have known a complaint communicated to 
the male by intercourse with a woman, laboring un- 
der pruritus ; it is very similar to that which infected 
the female, in its general character ; that is, there 
was great itching and swelling of the prepuce, the 
whole internal surface of which, together with the 
glans penis, were covered with an apthous efflo- 
rescence."! 

In one form of this complaint, there is a peculiar 
sensation experienced, described by the patient as 
being not so much of an itching, but a feeling as 
though insects were crawling about the parts, 
sometimes externally, at others high up the vagina. 
When this sensation is felt around the external 
parts, it induces a strong desire to scratch or rub 
it, but when it is situated within the vagina, she 
cannot relieve herself by this process ; in either 
case, it produces great nervousness. Pruritus is 
frequently connected with some uterine or ovarian 
difficulty. In some cases it is caused by constipa- 

*Dewees' Midwifery, page 123. 

tDewees' on Diseases of Females, page 61. 



190 THIRTY YEARS OP FEMALE LIFE. 

tion and piles, by an acrid discharge from the womb, 
or mucuous membrane of the vagina. It has also 
been known to arise from the hair on the labia 
turning inwards, irritating the inner surface of the 
genitals, as the inversion of the eyelashes sometimes 
cause irritation and inflammation of the eyes ; when 
this is the case, by removing the ofi'ending hairs, 
the complaint ceases. The treatment of this troub- 
lesome malady, will be modified according to the 
cause producing it, and the constitution of the pa- 
tient. In some cases, local or general bleeding will 
be indicated, bathing the parts with tepid water 
and milk, castile soap and water, or a tea of marsh- 
mallows or poppy heads, some of which should be 
injected up the vagina ; these simple washes will 
be found very grateful, particularly in cases where 
the vagina is hot and dry, indicating an inflamma- 
tory state ; when this is somewhat abated, or the 
disease of long standing and chronic, some of the 
astringent injections will do good, as sulphate of 
zinc, sulphate of iron, or alum. The chloride of 
zinc, three grains to the ounce of water, will suit 
some cases. Anointing the parts externally and 
internally with cod-liver oil, or chloroform half a 
a drachm, with one ounce of sweet oil, or simple 
cerate, and extract of hyoscyamus will be of ser- 
vice, also creosote five or six drops to the ounce of 
water, a solution of nitrate of silver eight or ten 
grains to the ounce of water is sometimes used ; 
from one to two grains of corrosive sublimate to 
the ounce of lime water, has been used with bene- 



THIRTY TEARS OF FEMALE LIFE. 191 

fit in some cases. In many cases the solution of 
borax, will effect a cure ; it may be made with half 
an ounce of borax, to half a pint or a pint of water, 
according to the sensibility of the parts, sometimes 
the solution will have a better effect if five or six 
grains of morphine or one or two table-spoonsful of 
laudanum is added to half a pint of the solution. 
The Goulard water is of benefit in some cases. The 
bowels should be freely evacuated, and kept in a 
soluble condition by saline aperients, and the warm 
hip bath occasional^ resorted to. The internal 
treatment will be governed by the general health 
of the patient. When pruritus occurs in pregnant 
women and is due to that condition ; if some of the 
above remedies do not cure the complaint, they 
will at least make the patient more comfortable 
until delivery takes place, when the pruritus usually 
ceases. 



CHAPTER XXI. 

HYDROMETRA, OR DROPSY OP THE WOMB. 

This is a collection of fluid in the cavity of the 
womb, sometimes thin and colorless like water, or 
it may be mucous, serous, purulent and bloody. It 
is evident that it cannot occur unless the passage 
through the neck of the womb is closed by adhe. 
sion, or obstructed by a morbid growth, as a poly- 



192 THIRTY YEARS OF FEMALE LIFE. 

pus, or some otherkind of tumor, or misplacement 
of the organ. In the latter case, while menstrua- 
tion continues, the fluid, if secreted, would escape 
with the menstrual discharge. But after this func- 
tion has finally ceased, it would be expelled only 
when it had accumulated in the uterine cavity in 
such quantity as to be forced out by the contrac- 
tions it induced, or by the resistance of the tissues 
of the womb overcoming the obstruction caused 
by the misplacement. Dropsy of the womb may 
occur in the virgin before or after menstruation has 
finally ceased, but it is more frequently met with 
before the turn of life, and with females who have 
had children ; it also occurs during pregnancy. 

The amount of fiuid contained in the uterine cav- 
ity is liable to great variation. Cases are recorded 
where it amounted to several gallons. In some 
cases, the womb, unable to contain so large a quan- 
tity, has burst, the fiuid escaping into the abdomi- 
nal cavity, producing fatal peritonetis ; it has also 
been known to force the obstruction and escape 
through the natural outlet. 

Symptoms. — The symptoms are both mechanical 
and sympathetic, as in pregnancy ; the abdomen 
gradually enlarges, until the patient feels more or 
less inconvenience from the pressure of the disten- 
ded womb affecting the neighboring organs. The 
stomach becomes sympathetically affected, there is 
loathing of food, nausea, and occasional vomiting ; 
the breasts enlarge, and the female often believes 
herself to be pregnant, until by a spontaneous evac- 



THIRTY YEARS OF FEMALE LIFE. 193 

uation of the fluid, or the enlargement continuing so 
long, she is obliged to change her opinion. Cases are 
mentioned by medical writers, where, under the im- 
pression that delivery was about to take place, the 
woman has summoned her attendants, repaired to 
bed, and while assisting the anticipated delivery by 
a bearing down effort, the obstruction has sudden- 
ly given way, followed by a copious discharge of 
fluid, and a collapse of the distended abdomen, put- 
ting to flight her anticipations of becoming a moth- 
er. Sometimes there is a quantity of gas contain- 
ed in the enlarged uterus with the fluid, and a sud- 
den escape of such a collection is often attended 
with a loud noise, to the no little chagrin of the 
patient. In some cases, there is more or less ten- 
derness over the region of the womb, and the wom- 
an presents a pale, bloated appearance, with great 
derangement of the general health, swelling of the 
extremities, obstinate constipation, thirst, hot skin, 
shiverings, rapid and feeble pulse, tongue coated, 
urine high colored and depositing a dark colored 
sediment resembUng brick dust, and as a general 
thing, suppression of the courses. The collection 
of fluid produces in many cases periodical pain, 
similar to labor, which the woman complains of as 
colics. The treatment consists in evacuating the 
contents of the womb, and repairing the enfeebled 
constitution, and preventing the reaccumulation of 
the fluid. In some cases, where there has been a ' 
spontaneous escape of the contents of the womb 
through the natural channel, it has ^ot filled again, 



194 THIRTY YEARS OF FEMALE LIFE. 

but this rarely happens. If the passage through 
the neck of the womb has become impervious from 
adhesion, a long and curved trocar is thrust into the 
uterine cavity, and the fluid allowed to escape 
through the canula, which should be left in the ar- 
tificial opening for some time to prevent its closing ; 
or this may be accomplished by introducing bougies 
from time to time for the same purpose. Where 
the neck of the womb is filled up by a polypus, or 
other tumor, it should be removed, if practicable. 
Sometimes, when the neck of the womb is occupi- 
ed by a tumor, or obstructed by a flexion of the 
organ, it may be dilated by introducing sponge 
tents, until it has become sufficiently opened to al- 
low the fluid to escape. In some cases, where the 
natural outlet has not beocme obliterated by adhe- 
sion, a few doses of ergot has brought on active 
uterine contractions, which has resulted in the es- 
cape of the contents ; or it has been removed by 
introducing the catheter into the uterine cavity. 
To prevent a reformation of the secretion, astrin- 
gent injections have been thrown into the cavity ; 
it has also been proposed to cauterize the lining 
membrane of the womb with nitrate of silver ; di- 
uretics are sometimes resorted to, as in general 
dropsy ; alteratives are also indicated, together 
with tonics, to improve the general health of the 
patient. 

Physometra, or Wind in the Womb. — Several 
authors describe a peculiar condition of the womb, 
which consists in a perverted action of its lining 



THIRTY YEARS OF FEMALE LIFE. 195 

membrane, secreting a gaseous fluid, which so dis- 
tends the organ, that pregnancy has been supposed 
to exist, and cases are recorded where this impres- 
sion has been carried so far, that the woman has 
made preparations for her lying-in ; at last, her an-' 
ticipations have vanished in the escape of a large 
quantity of gas from the uterine cavity. The exist- 
ence of this affection has been denied by some med- 
ical writers of great experience in diseases of wo- 
men. That there has been collections of air in the 
womb, observed under certain circumstances, is not 
doubted, but the question in dispute seems to be, 
the possibility of the womb containing a quantity 
of gas, distending the organ, as in pregnancy, and 
the passage through the neck of the womb pervious. 
The escape of the gas from time to time, proves 
that the passage is not permanently closed, at least; 
but why does it not escape as fast as generated ? If 
the passage was not obstructed, it would do so. 
When generated in the stomach, this organ con- 
tracts, overcomes the resistance of the muscular tis- 
sue of the cardiac or pyloric orifices, and the of- 
fending gas passes up out of the mouth, or down 
into the lower bowel, or it may be generated in this 
portion of the viscera. It is then expelled by the 
action of the abdominal muscles, compressing the 
intestines, or by the contraction of the muscular 
tissue of the bowels, forcing the seriform fluid down 
out of the body, overcoming in its course, the con- 
traction of the sphincter ani. The womb not being 
provided with a sphincter, if it contains a quantity 



196 THIRTY YEARS OF FEMALE LIFE. 

of gas, and the passage is not closed by adhesion, 
we must look for some other obstrncting cause ; this 
may be a flexion of the organ, a morbid growth at 
the mouth of the womb, or within the neck, a clot 
' of blood, a dead foetus, or some other substance 
within the cavity, resting upon, or partially within, 
the upper portion of the cervical canal. As previ- 
ously stated, some of the above conditions of the 
womb produce an obstruction of the menstrual se- 
cretion, which results, in some cases, in the accumu- 
lation of a quantity of bloody fluid within the uter- 
ine cavity. By those who have described this dis- 
ease, it is stated that the wind in the womb is some- 
times generated or secreted by the membrane lining 
its cavity. It is easy to understand how it can be 
generated by the decomposition of a vegetable or 
animal substance, but how a mucous membrane can 
secrete or exhale air, is past finding out. As we do 
not expect to find a vegetable substance in the ca- 
vity of the womb, the conclusion arrived at, is that 
the gas is formed in consequence of the decomposi- 
tion of an animal substance, and this may be a clot 
of blood, a piece of the after-birth, some portion of 
the membranes, a dead foetus, or it may be, an ulcer, 
or a decomposition of mucous, secreted by the inner 
surface of the womb. The gas is sometimes inodor- 
ous, at others very off*ensive ; more or less fluid, also 
escapes with the gas in some cases. Women of a 
delicate or feeble constitution are more subject to it 
than others. When the after-birth, or a portion of 
it, is retained in the womb for a number of days 



THIRTY YEARS OF FEMALE LIFE. 197 

after delivery or abortion, it is not a rare circnm- 
stance to find it in a putrid condition, and its re- 
moval attended with the escape from the womb, of 
a bloody fluid, and a quantity of gas of very bad 
odor. At child-birth, there is sometimes an escape 
of wind from the vagina, and occurs in this way ; 
the womb being forced down at delivery, shortens 
the vagina, but when the child has escaped from 
the parts, the womb recedes to a higher position^ 
which has the effect to draw air into the vagina ; 
when the woman makes a bearing down effort to as- 
sist in expelling the after-birth, the womb is forced 
down again, expelling the air in the vagina with a 
loud noise, in some cases. There is no doubt, this 
has sometimes been mistaken for an escape of wind 
from the womb. Something very similar is some- 
times observed in cases of falling of the womb; 
when the female is on her feet, the womb settles 
down near the lower outlet ; when she lies down, it 
recedes, as in the previous case, and as soon as she 
rises, the womb settles down again, expelling the 
air in the vagina. The symptoms and treatment of 
wind in the womb does not differ materially from 
that mentioned under the head of hydrometra. 



198 THIRTY YEARS OF FEMALE LIFE. 



CHAPTER XXII. 

PREGNANCY. 

Reproduction or propagation of the species, is a 
universal law, manifested in some peculiar form 
throughout the animal and vegetable kingdoms. 
In some of the lower orders of plants and animals, 
the process of reproduction is very much alike, but 
as we ascend the scale of animated beings, the 
phenomena becomes more dissimilar and mysterious, 
culminating in man, the master-piece of the Cre- 
ator. If we look no further back in the world's 
history than the time of Hippocrates, we shall find 
that for more than two thousand years, the pheno- 
mena of human pregnancy has been an interesting 
subject of investigation in every age, and still the 
interest continues, and the mystery remains unex- 
plained, in many important particulars. To review 
the different theories that have been promulgated 
from time to time, in regard to impregnation, would 
occupy much time, and far exceed our limits, and at 
the same time, such a course would be foreign to 
the object of this treatise ; we shall, therefore, be 
content with simply adverting to the generally re- 
ceived opinion at the present day, and pass to the 
effects on the female organism, resulting from con- 



THIRTY YEARS OP FEMALE LIFE. 199 

ception. By referring to what has been previously 
stated in regard to the ovaries, we shall find that 
they are situated on each side of the womb, in size 
about as large as pigeons' eggs, and composed, to a 
great extent, of little vesicles, one of which escapes 
through the fallopian tubes into the womb, making 
its exit out of the body at every period of menstru- 
ation. The ovaries resemble the little eggs, found 
in the bodies of female birds, and the term, ovaries, 
signifies a collection of eggs. The term conception, 
therefore, means the impregnation of one of these 
little ovarian vesicles, or eggs, from connexion of 
the sexes. When the sexual union has been suc- 
cessfully accomplished, the fluid, or semen, from the 
male, is injected into the vagina, from whence 
some portion of it is conveyed by a mysterious pro- 
cess, into the womb, through the fallopian tubes, 
and deposited on the ovaries. When the act of 
copulation has resulted in impregnating an ovarian 
vesicle, it leaves the ovary a germ of a new being, 
passes through the fallopian tube, and enters the 
womb, where, under favorable circumstances, it goes 
through the different stages of development. 

Such, then, in a few words, is the theory of con- 
ception at the present day, recognized by men of 
great scientific attainments. Without wishing to 
enter into the discussion of a question, that we con- 
sider admits of assertions only, on both sides, we 
simply remark, that the present theory of concep- 
tion, although not quite satisfactory to us, still we 
consider it more rational than many that have pre- 



200 THIRTY YEARS OF FEMALE LIFE. 

ceded it, and also supported by investigations of 
modern origin. But, notwithstanding the light shed 
upon this subject by aid of the microscope, the veil 
of obscurity that has surrounded the phenomena of 
impregnation from the earliest ages till the present, 
this important instrument has not been able to re- 
move. It has elucidated some points connected 
with this subject, but others of greater importance, 
it has not, and could not be expected to explain. 
We can safely say, however, without the fear of 
contradiction, that under favorable circumstances, 
copulation results in impregnation, and that when 
the ovaries of the female, or testicles of the male 
are removed, conception cannot take place. It is, 
therefore, evident that these organs play an import- 
ant part in the process of reproduction ; but how 
the semen reaches the ovaries, through the womb 
and fallopian tubes, aside from the fact, that a com- 
mon size bristle fills the passage of the tubes at 
their entrance into the womb, is but one of several 
features of this mysterious process, as yet but par- 
tially explained. Immediately after conception, the 
womb commences to increase in size, from a greater 
determination of blood into its vessels, and at the 
same time, the inner surface of the womb secretes 
a new substance, which is developed into a 
membrane called the decidua. The cavity of 
the womb is lined with this membrane, before 
the impregnated ovum reaches it. When the 
ovum enters the cavity of the womb through 
the fallopian tube, it pushes before it that 



THIRTY YEARS OF FEMALE LIFE. 201 




A A, the Fallopian Tubes at their entrance into the Womb. B, the OTum having 

entered the Womb, through the Fallopian Tube, pushes the membrane before 

it, thereby forming a bag. C, the Membrane lining the cavity of the 

Womb. D, the passage through the neck of the Womb. E, the 

cavity of the Womb. 

portion of the decidua, opposite the moutli of the 
tube, thereby forming a bag, which increases in size 
as the foetus developes; two other membranes are 
described as enveloping the foetus, the chorion and 
amnion ; the last is separated from the embryo by 
the water or amniotic fluid. The placenta, or after- 
birth, is usually attached to the upper part of the 
womb ; in some cases, however, it is attached to the 
side, or over the passage through the neck of the 
organ ; the after-birth begins to be formed about 
the fifth or sixth week. The foetus is connected 
with the placenta, by means of the navel string, or 
umbilical cord ; this is composed of two arteries 
and one vein, and usually proceeds from the centre 
of the after-birth, sometimes from the edge of it. 

The impregnated ovum does not always reach 
the cavity of the womb ; it may remain in the 



202 THIRTY YEARS OF FEMALE LIFE. 

ovary, the fallopian tube, or it may escape into the 
cavity of the abdomen ; in either case, it is called 
extra-uterine pregnancy. When the impregnated 
ovum is arrested in its course through the fallopi- 
an tube, it is called tubal pregnancy ; when the 
ovium remains in the tube, it increases in size just 
the same as though it had found its way into the 
uterine cavity, the tube is distended into a kind of, 
sac to the sides of which the placenta is attached ; 
when the development of the ovum has continued 
for two or three months, the tube finally bursts 
from over distension, and the patient usually dies 
from internal hemorrhage, or inflammation of the 
peritoneum. When the impregnated ovum remains 
in the ovary, it 4fe called ovarian pregnancy ; here 
it goes through the same process of attachment and 
development as in the tube, but it may remain six 
or eight months, and in some cases longer, in this 
location, before the sac in which it is contained is 
ruptured ; when this does occur, the same results 
follow as in the previous case. In the other form 
of extra-uterine pregnancy, the ovum is attached to 
some portion of the intestines, where a sac is form- 
ed, containing the foetus, its membranes, water, and 
placenta, as though it was in the uterine cavity ; 
this is called ventral pregnancy ; in this situation 
the foetus may remain, not only during the term of 
gestation, but for many years ; a case is recorded, 
where a female carried a child, under these circum- 
stances, over fifty years. 

" In ovarian pregnancy, the fatal termination is 



THIRTY YEARS OF FEMALE LIFE. 203 

merely postponed till a later period, during which 
the patient has to undergo attacks of most terrible 
suffering ; at length, after a paroxysm more than 
usually severe, and frequently attended with the 
sensation of something giving way in the abdomen, 
faintings come on, speedily followed by death. 
During the attacks, there is obstinate constipation, 
which is attended with painful and fruitless efforts 
to evacuate the bladder and rectum ; the face is 
pale, and expressive not only of the most acute suf- 
fering, but of great anxiety and mental depression ; 
nevertheless, in the intervals of the attacks, she 
feels easy, and appears well and cheerful. The 
termination of ventral pregnancy is very different ; 
after a time the foetus dies, and may either remain 
enclosed in the cyst for life, or it may be discharged 
in portions, by means of an abcess, either through 
the intestines, uterus, vagina, or abdominal parietes. 
Cases have occurred where it has come away by 
the bladder ; in the former case, where it is retain- 
ed, it diminishes more or less in size, becomes hard 
and closely packed together, and in some instances 
incrusted with a layer of calcareous matter."* 

Development op the Ovum. — As previously 
stated, the impregnated ovum enters the uterine 
cavity through the fallopian tube ; this occupies a 
number of days. Maygrier says, " we see nothing 
in the uterus previous to the seventh day, to indi- 
cate the existence of a new being. From the 
twelfth to the thirteenth day, there is a vesicle as 

* Rigby'8 Midwifery, page 106. 



204 THIRTY YEARS OF FEMALE LIFE. 

large as a pea, containing a thick fluid, in the midst 
of which swims an opaque point. It is thought 
that the heart alone exists at this period. Its 
weight is estimated at one grain. 
At the twenty first day it weighs 
from three to four grains. At the 
ovum of about two thirtieth day, the embryo resem- 

weeks natural size, blcs a WOrm, which is CUrlcd Up. 

We observe at this period, some 
very faint traces of the principal 
organs, and of the situation of the 
upper extremities. It weighs from 

"^'"rgnTd!'"' ^^^ ^^ ^^^ g^^i^s^' ^^d its length 
is about one inch. 






Embryo of about one month, natural size. 

" At the forty-fifth day, the form of the child is 
very distinct.'' Ossification commences, " the limbs 
appear in the form of tubercles, resembling the 
sprouts of vegetables. The eyes, mouth and nose, 
are marked by blackish points and lines. Its weight 
is one drachm, its length two inches. At two months, 
all the parts of the foetus are present, the dark points 
which represents the eyes, enlarge ; the eyelids 
may be traced, and appear transparent ; the nose 
begins to be prominent ; the mouth enlarges and 



THIRTY YEARS OF FEMALE LIFE. 205 

opens : the brain is soft and pulpy ; the neck shows 
itself: the heart is very much developed, and 
opaque lines are seen to proceed from it, which 
are the first traces of the large vessels. The fin- 
gers and toes are distinct. Its weight is five drachms 
and its length four inches."^ 



Ovum of about two months, the membranes in which it is enclosed laid open. 
A, the After -birth, just beginning to be formed. 

" Although the genital organs are now visible, it 
IS, however, difficult to distinguish the sex, the 
clitoris and penis having an identical develop- 

ment.'^t 

w — ■ 

*Maygrier's Midwifery, page 69. 
fChaiUy's Midwifery, page 23. 



206 THIRTY YEARS OF FEMALE LIFE. 



CHAPTER XXIII. 

SIGNS AND SYMPTOMS OF PREGNANCY. 

Pregnancy usually manifests itself by certain signs 
and symptoms, which the female readily recognizes 
as indications of this condition. Some women can 
tell immediately after sexual intercourse, that con- 
ception has occurred ; others again, are not aware 
of it until they feel the motions of the child. In 
other cases, the usual symptoms are so obscure, or 
complicated with some abnormal condition of the 
system, that not only the woman herself has been 
deceived, but even physicians have been known to 
commit serious mistakes in consequence. 

One of the indications of pregnancy usually obser- 
ved, is an interruption of the menstrual flow ; yet 
this sign is liable to great variation, as it is a com- 
mon occurrence for the courses to make their ap- 
pearance once, after conception has occurred, and 
others menstruate regularly during the first three 
or four months ; and in rare cases, this function con- 
tinues through the entire nine months. Dr. Dew- 
ees says, he knew of an instance where the mother 
and daughter, continued to menstruate until the 
seventh month of pregnancy. Heberden mentions 
a case, where the flow was regular up to the time of 
delivery. Nicholson, Mayo, and others, relate simi- 



THIRTY YEARS OP FEMALE LIFE. 207 

lar cases. Placing too much reliance on this sign 
of pregnancy has resulted in destroying the child 
in the womb, in a number of instances, where 
women have been executed for some capital crime, 
after being examined and pronounced not pregnant, 
because they menstruated. Riolin mentions having 
publicly dissected before the medical class, the 
body of a woman who was hanged for robbery, 
when, upon opening the womb, she was found to be 
pregnant, and to have completed more than half 
her time ; yet, the physicians who examined her, 
pronounced her not pregnant. Mauriceau mentions 
a similar case, and Montgomery relates the follow- 
ing : " During the French Revolution, a countess, 
who was sentenced to the guillotine, declared her- 
self pregnant, and was, in consequence, examined 
by some of the most experienced midwives in Paris, 
who declared her plea to be false ; but, after exe- 
cution, she was found, on dissection, to have been 
far advanced in pregnancy with twins."* 

Some women menstruate only when they are 
pregnant, and others become pregnant that do not 
menstruate. Cases are recorded, of women becom- 
ing pregnant, after the apparant final cessation of 
menstruation. It often occurs to young females, 
immediately after marriage, to have their courses 
stop for two or three periods, after which they be- 
come regular again, without any appearance of a 
miscarriage. Women that are nursing, frequently 
have their menstruation regular. From what has 

♦ Montgomery on Pregnancy, page 66. 



208 THIRTY YEARS OF FEMALE LIFE. 

been stated, it is evident that the fact of menstru- 
ation continuing, does not prove the non-existence 
of pregnancy, neither can the absence of the 
monthly flow be taken as a sure indication that the 
female is pregnant, although followed by other signs 
of pregnancy, as previously stated under the head 
of obstructed menstruation. Yet, as most women 
in good health, and previously regular, do not have 
their courses if pregnant, all deviations from this 
course should be considered as exceptions to the 
rule. 

Morning Sickness. — Women generally, are trou- 
bled more or less with nausea and vomiting soon 
after impregnation ; as it frequently occurs soon 
after rising, it has been called the morning sickness. 
It usually commences about the sixth or eighth 
week, and ceases soon after quickening ; in some 
cases, it occurs during the first week of pregnancy, 
and some women are afflicted with it most of the 
time they are pregnant. Sometimes it is merely a 
throwing up of a watery, glairy fluid, at others the 
food is rejected as soon as partaken of. In some 
cases, after having vomited the morning meal, she is 
able to eat again immediately, and retain it; and on 
the following morning the same thing occurs again, 
without producing any further inconvenience. At 
other times, the smell or sight of food is sufficient to 
cause nausea and vomiting, at any time, which some- 
times becomes so constant and severe, that she suf- 
fers for the want of nourishment, and cases are re- 
corded, where it has caused abortion, and even the 



THIRTY YEARS OF FEMALE LIFE. 209 

death of the woman. Some females are free from it 
entirely, and enjoy a better state of health when 
pregnant than at any other time. 

Treatment. — In some cases, if the woman will 
partake of a little food before rising in the morning, 
as a piece of toast and a cup of tea, she will escape 
the annoyance of being sick at the stomach ; but 
where the vomiting still persists, and the patient is 
of full habit, bleeding will frequently do good, or a 
mustard plaster, or a cloth wet with laudanum, ap- 
plied to the stomach ; sometimes leeches are ap- 
plied with benefit ; sometimes a piece of ice held 
in the mouth, and as it melts, allowed to pass into 
the stomach, will check the sickness ; soda water, 
also, or a seidlitz powder, is often of service ; the 
mineral or vegetable acids are recommended. The 
compound spirits of lavender, or the ammoniated 
tincture of valerian suit some cases ; mint tea, or a 
few drops of the essence of peppermint and water, 
do good ; chalk mixture, or magnesia, and other 
remedies of this class will often relieve, if not cure 
the difficulty ; creosote has been recommended, also 
a few drops of spirits of turpentine. If there is 
much pain in the stomach, laudanum, opium, or hy- 
oscyamus will often have a good effect ; sometimes 
a tea of camomile flowers or hops will be of great 
service, or the following : — subnitrate of bismuth, 
ten grains, extract of gentian, or extract of Colombo, 
thirty grains ; make fen pills, one, three or four 
hours apart. Spirituous liquors are beneficial some- 
times ; an injection up the back passage, containing 



210 THIRTY YEARS OF FEMALE LIFE. 

laudanum, or some preparation of opium, has been 
recommended. The bowels should be kept open 
by gentle aperients. Some obstinate cases are 
cured only by delivery, at full term, or by premature 
delivery. 

Heartburn. — Some women are troubled more or 
less with heartburn ; it frequently occurs in the 
early part of pregnancy, and ceases in a few weeks; 
at other times, it continues during most of the term 
of gestation, and may be very distressing. As it is 
frequently associated with acidity of the stomach, 
soda or magnesia will be useful ; also ammonia, or 
the liquor potassa ; sometimes the mineral or vege- 
table acids do good ; the bitter infusions, as in the 
previous case, are often of service ; also lavender 
or valerian. Some women find that chalk gives 
them relief, and consume large quantities of it. Dr. 
Dewees mentions the case of a lady, " who was in 
the constant habit of eating chalk during the whole 
term of pregnancy ; she used it in such excessive 
quantities as almost rendered the bowels useless. 
We have known her, many times, not to have an 
evacuation for ten or twelve days together, and 
then only procured by enemata, and the stools were 
literally nothing but chalk. Her calculation, we well 
remember, was three half pecks for each pregnancy. 
She became as white, nearly, as the substance itself, 
and it eventually destroyed her, by deranging her 
stomach so much, that it would retain nothing what- 
ever upon it.''* 

* Dewees' Midwifery, page 275. 



THIRTY YEARS OF FEMALE LIFE. 211 

Longings. — Pregnant women sometimes experi- 
ence a strong desire, or longing for articles of diet, 
which they could not be prevailed upon to touch at 
any other time ; in some instances, the articles 
longed for are of the most unnatural and revolting 
kind. It used to be a common opinion, that a wo- 
man should be indulged in this respect, for fear that 
some injury might happen to her, or that the child 
might come into the world, bearing the mark of the 
article longed for by the mother ; whether such a 
result would be likely to occur or not, it is well 
enough to gratify a fancy for such things as have no 
tendency to injure either mother or child, but when 
the longing oversteps the bounds of reason, and the 
woman desires crude, unwholesome, and indigestible 
substances, calculated to injure her or the child, it 
would be worse than folly to indulge such a desire. 
This perverted taste sometimes assumes the form of 
antipathy for certain articles of diet, that the wo- 
man was formerly in the habit of enjoying. At 
other times the appetite for wholesome food is 
so greatly increased, that she is not satisfied with 
her regular meals, but is obliged to eat several 
times between meals, and even get up in the night 
to satisfy her appetite. 

Changes in the Breasts. — Enlargement of the 
breasts is usually observed in pregnancy ; in some 
cases, this change occurs a few days after concep- 
tion ; in other cases, not till the full term is nearly 
completed ; and instances are mentioned, where 
they did not show any increase in size until 



212 THIRTY YEARS OP FEMALE LIFE. 

after the birth of the child. Usually, however, 
about the second or third month, the female experi- 
ences tingling pains in the breasts, with a feeling of 
fullness ; they are hard, and tender to the touch, 
and begin to enlarge ; the veins increase in size, the 
nipple becomes more prominent ; the circle around 
the nipple assumes a different color, becomes darker, 
and little elevations are observed, like pimples. In 
some cases, they are so swollen and painful that it is 
necessary to rub them often with camphorated oil. 
As an indication of pregnancy, too much reliance 
should not be placed on the enlargement of the 
breasts, for several other causes may produce the 
alteration in size and appearance, and pregnancy 
may exist without affecting the breasts. Immedi- 
ately after marriage, some females experience pains 
in the breasts, with enlargement, although not preg- 
nant ; the same thing is frequently observed in con- 
sequence of enlargement of the womb from a tumor, 
and other conditions of the system. 

Enlargement of the Abdomen. — An increased 
development of the womb, is, as a necessary conse- 
quence, followed by enlargement of the abdomen, 
which becomes more or less prominent, according 
to the form of the woman ; some being larger at 
four months than others at six. It usually begins 
about the third month ; with women who have had 
children, it is not generally observed as soon as in 
cases of first pregnancy ; with the enlargement of 
the abdomen, there is also, in most cases, a greater 
prominence of the navel, and in some cases, partic- 



THIRTY YEARS OP FEMALE LIFE. 213 

ularly in first pregnancy, there is a tenderness of 
the abdomen, but it is not confined to the immedi. 
ate region of the womb ; the woman usually com- 
plains of the entire abdomen being tender to the 
touch, in consequence, probably, of a stretching of 
the integuments. 

As an indication of pregnancy, enlargment of the 
abdomen is a sign of little importance ; many cases 
having occurred, where the female has been pronoun- 
ced pregnant, when the enlargement was caused 
by a tumor, collections of the menstrual secretions 
in the womb from imperforate hymen, or adhesion of 
the walls of the vagina, or closure of the mouth of 
the womb, and other causes. Dr. Dewees mentions 
the case of a young girl, who commenced to men- 
struate when between twelve and thirteen years of 
age ; after a time, she was taken sick, but her 
courses did not return after her recovery ; her ab- 
domen began to enlarge, she had morning sickness, 
the breasts enlarged ; a physician who was consul- 
ted in regard to her case, after enquiring into the 
symptoms and examining the abdomen, pronounced 
her pregnant. Not feeling satisfied with this decis- 
ion ; Dr. Dewees was consulted, who found the ab- 
domen considerably enlarged from a tumor, prin-i 
cipally in the left side, which proved to be an en- 
largement of the spleen. '^ No tumor was to be 
found in the pubic region, consequently the uterus 
was not found enlarged ; the navel was sunk, and 
upon an attempt to pass the finger into the vagina, 
I found so much evidence of her continency, that I 



214 THIRTY YEARS OF FEMALE LIFE. 

did not persevere, being perfectly satisfied, from 
the condition of the parts, that she was a virgin. 
I unhesitatingly, and with no common degree of 
pleasure, declared the poor child to be free from 
the charge so heedlessly and cruelly prefered 
against her.'' 

In relation to the same subject. Dr. Montgom- 
ery relates the following : " A well educated young 
woman, mistress of an infant school, established by 
a family of rank and fortune, in one of our midland 
counties, was observed to be large in her abdomen, 
and to exhibit several symptoms of deranged health; 
in consequence of which, she was visited by a med- 
ical man, who discovered in the abdomen, a tumor 
as large as, or in other respects resembling, a gravid 
uterus of six months ; but the catamenia were de- 
clared, but not believed, to be quite regular ; nor 
were there present, mamary changes indicative of 
conception ; but she was pronounced pregnant, and 
another and more senior practitioner confirmed, in 
the strongest terms, the opinion already given ; the 
truth, or possibility of which, the young woman 
most solemnly denied ; the family, under whose 
patronage she had hitherto lived, entertained the 
highest opinion of her morals and veracity ; but the 
medical opinion was so strong and unqualified, that 
she was removed from her situation, and sent to 
town, never to return, except she brought, from me, 
a certificate that she was not in the condition at- 
tributed to her. On examination, I readily discov- 
ered in the abdomen, a fibrous tumor, but no symp- 



THIRTY YEARS OF FEMALE LIFE. 215 

torn of pregnancy ; she was actually menstruating 
at the time she came to me ; the breasts were flac- 
cid and unchanged. I gave the necessary certificate 
and, after remaining a month under my observation, 
she returned home ; and, was within a year, mar- 
ried to a young man who had been attached to her 
before the imputation had been cast on her char- 
acter ; unfortunately for her, she soon afterwards 
proved pregnant, had a very severe labor, followed 
by inflammation, which ended in death. "^ 

A melancholy case is related by Dr. Bedford, 
Professor of Obstretics in the University Medical 
College of this city. Dr. Bedford was called to vis- 
it a young lady in New Jersey, whom he found to 
be in the last stage of consumption, and from her 
appearance, it was evident that death would soon 
claim her for his victim. On entering her room, 
she said, with a smile of angelic sweetness " I am 
glad to see you, on my father's account, for he will 
not believe that I cannot yet be restored to health ; 
but life has lost all its charms for me ; I long only 
for the repose of the grave." The history of the 
case was this. At an early age, her mother died, 
and having no other children, her father, a clergy- 
man of high standing in the English Church, lav- 
ished upon her a father's undivided love ; her edu- 
cation he attended to, principally, himself, being 
well qualified for this duty by his amiability and 
talents, and saw, with pride, his only daughter ripen 
into womanhood, with every prospect of being a 

♦ Montgomery on Pregnancy page 67. 



216 THIRTY YEARS OF FEMALE LIFE. 

comfort and a blessing to him in his declining years ; 
but it was decreed otherwise. Having attained 
her eighteenth year, she engaged herself in marri- 
age to a young barrister, a man of excellent char- 
acter and high attainments. In a short time after 
her engagement, she began to decline in health, 
became irregular in her menstruation, subject to 
nausea and vomiting, the abdomen and breasts enlar* 
ged, manifesting some of the usual symptoms due to 
pregnancy. The alteration in her appearance was 
observed by some of her female acquaintances, who 
soon circulated the vile slander, that she was preg- 
nant. This unjust report was communicated to 
her intended, who, without inquiring into the truth 
or falsity of the rumor, wrote to her father and 
requested to be released from the engagement; 
this was immediately granted. The young lady, 
conscious of her innocence, and trusting in that 
God she had been early taught to revere, request- 
ed that a physician might be called, who, she be- 
lieved, would ascertain the nature of her malady 
and put to shame her vile traducers. The physi- 
cian was called, and after inquiring into her symp- 
toms, he informed her father that there could be no 
doubt of her condition ; she was evidently with 
child ; and advised him to take some course imme- 
diately, to keep the affair from gaining any further 
publicity. Her father, never for a moment doubt- 
ing his danghter's innocence, spurned the advice 
with just indignation, and called in other medical 
men, who held a consultation in regard to her case. 



THIRTY YEARS OP FEMALE LIFE. 217 

and after due deliberation, the previous opinion 
was confirmed. Upon this they decided to leave 
England, and seek a home in America. They gath- 
ered up their little property, and with heavy hearts 
bid adieu to their once happy home, to seek among 
strangers, an asylum where they might hide their 
shame. "While on the passage, the daughter was 
quite ill from sea sickness, and a medical man on 
board the vessel was consulted ; he, forming an 
opinion from her general appearance, believed her 
pregnant, and remarked to the father, that there was 
great danger of her having a premature delivery. 
Soon after arriving in this country. Dr. Bedford was 
requested to see her, who, after a minute and careful 
examination, pronounced her not pregnant, but 
afflicted with a fibrous tumor of the womb, and so 
far gone with consumption, that a restoration to 
health was out of the question. On being inform- 
ed that she was not pregnant, her father evinced 
no surprise, as he had never entertained such a 
suspicion ; but when informed that she was past 
cure, he was bowed down with grief. In a few 
.weeks from this interview, this much injured girl 
was beyond the reach of lying tongues ; death had 
claimed his victim. Dr. Bedford was informed of 
her death, and requested to make a post-mortem 
examination, which he did, in the presence of other 
medical men, and he says, " as I removed the tumor 
from the womb, her father seized it convulsively, 
and exclaimed, * this is my trophy, and I will re- 



218 THIRTY YEABS OF FEMALE LIFE. 

turn with it to England, and it shall confound the 
traducers of my child.' "^ 

This is not a fancy sketch, but a stern reality ; 
a sad commentary on the mischievous influence of 
forming an opinion from appearances, unsubstanti- 
ated by a judicious examination, and should be a 
warning to females not to condemn one of their sex 
on suspicion. For who can imagine the mental 
sufferings of a virtuous female, degraded in the 
circle of her acquaintance, by the withering curse 
of the slanderer's lying tongue ? And what satis- 
faction it mustbe to those who, when consulted in 
regard to such cases as those above related, can say, 
the charge is false, you are not pregnant. The 
arduous duties of an active professional life are 
well repaid, by the feelings within every honest 
heart, to be able thus to vindicate female virtue. 

CosTiVENESS. — Pregnant women are subject to 
costiveness, caused by pressure of the enlarged womb 
upon some portion^ of the intestines, derangement 
of the digestive function, or from an increased ac- 
tion of the reproductive organs, and an inactive 
state of the bowels. In some cases, the patient has 
an evacuation every three or four days ; in other 
cases, one or two weeks elapse without a movement 
of the bowels ; and cases are recorded, where the 
woman has gone for months without a passage. 
The inconvenience arising from this torpid state of 
the bowels, varies according to its degree ; headache 

♦ Bedford on Diseases of Women and Children, page 62. 



THIRTY YEARS OF FEMALE LIFE. 219 

is a frequent result, also variable appetite, nausea 
and vomiting ; restlessness, particularly at night, 
and unpleasant dreams, swelling of the extremities, 
piles, pain in the back and abdomen, which some- 
times results in bringing on premature delivery, 
from the violent straining to induce a passage ; 
sometimes the more liquid portion may pass at 
stool, and the patient think she has had a natural 
passage, at the same time experience little relief, in 
consequence of the lower part of the rectum being 
filled up with the more solid portion, which has be- 
come so hard and dry, that it is with great difficulty 
removed. A costive state of the bowels, exceeding 
two or three days, should be attended to, and at first 
a mild course of treatment is best, for it frequently 
succeeds ; besides, very active medicines, particu- 
larly if they contain aloes, have been known to pro- 
duce abortion. The patient had better try what 
can be done by dieting, in the first place, together 
with the free use of ripe fruits, stewed prunes, and 
the like. If this course is not sufficient, injections 
may be resorted to with great advantage ; in obsti- 
nate cases, cathartics will be required, such as senna 
and manna, magnesia, cream of tartar, rhubarb and 
magnesia, castor oil, extract of butternut, or any 
other preparation suitable to the condition of the 
woman ; hyoscyamus combined with some of the 
above remedies, will often have a good efi'ect. It is 
a common occurrence for women, after delivery, 
to be troubled, more or less, with costiveness, contin- 
uing, in some cases, most of the time they are nur- 



220 THIRTY YEARS OF FEMALE LIFE. 

sing ; the bowels should be kept regular by some of 
the above remedies. 

DiARRHGEA. — Pregnant women are subject to fre- 
quent attacks of diarrhoea, coming on from time to 
time, during the term ; in some cases, it has been 
known to occur immediately after conception. A 
moderate looseness of the bowels will not require 
any special treatment ; but where it assumes a 
more active form, as frequently happens, it should 
not be neglected ; it may excite contractions of the 
womb, resulting in abortion, particularly when it as- 
sumes the character of dysentery, which is usually 
accompanied with tenesmus. The evacuations may 
be simply the usual discharge, in a more liquid 
state than natural, or they may be dark colored, 
very offensive, watery, and acrid, accompanied with 
headache, foetid breath, bad taste in the mouth, loss 
of appetite, debility and prostration. The liver is 
frequently in a torpid condition, the bile unhealthy 
and irritating. The treatment will be governed by 
the frequency and character of the evacuations ; to 
act on the liver, some preparation of mercury, as 
chalk and mercury, or podophyllin and leptandrin, 
or extract of dandelion, will be indicated; also 
small doses of rhubarb and ipecacuanna, chalk 
mixture with some astringent, as catechu or kino, 
and other astringents ; bearing in mind that the 
discharge should not be checked too suddenly ; par- 
ticular attention should be paid to the diet. In 
some cases, great benefit is derived from anodyne 
injections, as half a tea-cupful of thin starch, with a 



THIRTY YEARS OF FEMALE LIFE. 221 

tea-spoonful of laudanum. To quiet the nervous sys- 
tem, some preparation of opium will be required, 
or the camphor mixture, compound spirits of laven- 
der, or ammoniated tincture of valerian. 

Piles. — Females are often afflicted with piles, 
whether married or single, pregnant or not ; but 
during pregnancy, they occur more frequently than 
at any other time, as the result of costiveness, or 
from pressure of the enlarged womb on the blood 
vessels. They are external or internal, bleeding or 
blind piles, according to whether there is a discharge 
of blood from them or not. They frequently cause 
great distress, increasing the discomfort of the 
pregnant female ; the pain experienced at stool, 
often induces the woman to go as long as possible 
without an evacuation of the bowels, w^hich only in- 
creases the complaint. Piles are enlarged blood 
vessels, and are usually preceded by a sensation of 
weight and fullness in the lower part of the rectum, 
with a stinging, pricking sensation about the en- 
trance ; or there may be sharp, darting pains 
through that region, extending to the neck of the 
bladder, or lower part of the back. Sooner or 
later, little elevations make their appearance around 
the entrance to the rectum, which enlarge from 
time to time, attaining the size of peas, filberts, and 
in some cases much larger. If the piles are intern- 
al, they are sometimes forced down externally, when 
straining at stool ; at such times they often burst 
and bleed profusely, producing great prostration; 
even a dangerous hemorrhage has been known to 



222 THIRTY YEARS OF FEMALE LIFE. 

occur ; or in cases where they are not forced down 
externally, hemorrhage sometimes takes place from 
them. In some cases, they are so very sensitive, 
that the patient cannot sit down, and standing or 
walking is attended with great inconvenience ; 
they are sometimes forced down externally, and do 
not return again into the passage ; the sphincter 
ani contracting upon them, they become strangula* 
ted ; the suffering is then very intense ; sometimes 
they inflame and ulcerate. In some cases, there is 
a periodical bleeding from the piles, resembling in 
regularity, the menstrual function. The treatment 
consists in freely evacuating the bowels by injec- 
tions, and keeping them regular and a little loose, 
by saline aperients ; sulphur and cream of tartar, 
or castor oil, and other preparations of this class, in- 
jections up the rectum, of half a pint of cold water, 
three or four times a day, is a valuable remedy ; to 
relieve the irritation, warm emolient or anodyne in- 
jections give relief, as marsh-mallow tea, gruel, milk 
and water, with a few drops of laudanum, or a de- 
coction of poppies ; if the piles are external, apply 
leeches, solution of sugar of lead, solution of alum, 
decoction of oak bark, stramonium, ointment, or the 
following : — sulphate of zinc, one drachm, powdered 
opium, twenty grains, lard, half an ounce ; anoint 
the piles with it. " The balsams have also been 
highly recommended ; and recently, pix nigra, in 
five grain doses, has been stated to have been suc- 
cessfully used, after other remedies had failed.'^* 

* Churchill on Diseases of Women, page 516. 



THIRTY YEARS OF FEMALE LIFE. 223 

It is often necessary to remove the piles by an 
operation, but this should rarely be resorted to, if 
the woman is pregnant, as abortion might be induced. 
When the internal piles have been forced down ex- 
ternally, they can sometimes be returned by press- 
ing them firmly with the fingers, previously smeared 
with oil or lard. It has, also, been proposed to 
cure them by means of constant pressure from a 
kind of pessary. 

Enlarged Veins. — Some women are subject to 
this malady every time they become pregnant, un- 
less they miscarry before it is time for the difficulty 
to manifest itself. It is usually confined to the 
veins of the legs ; in some cases, the veins of the 
thighs, abdomen, labia, vagina or neck of the womb 
enlarge, and in some rare cases, the veins of the 
upper portion of the body are affected, presenting 
an uneven, knotty appearance. They usually make 
their appearance about the middle of the term, 
sometimes earlier ; in other cases, not till the latter 
part of pregnancy. Pressure of the womb on the 
veins within the pelvis, is regarded as the cause of 
the complaint ; sometimes the veins on one side 
are affected much more than those on the opposite 
side, in consequence of the womb leaning more to 
that side. Pregnancy is not the only cause of this 
malady ; any difficulty that produces an enlargement 
of the womb, or presses upon the blood vessels 
within the pelvis, as tumors, may occasion it. 
Women of a full habit are more subject to it than 
others ; it also occurs in females of a lax or weakly 



224 THIRTY YEARS OF FEMALE LIFE. 

habit. It is not so often met \vith during the first 
pregnancy, but seems to increase with the subse- 
quent ones ; women that are obliged to be much on 
their feet, are more liable to it than others. The 
enlarged veins are not often painful, but they cause 
a sense of fullness or numbness, and the limb feels stiff 
and sometimes subject to cramps; walking is attended 
with considerable difficulty. After child-birth, they 
usually subside, causing no further trouble ; in 
some cases, however, they burst, and bleed copious- 
ly. When the veins of the leg ulcerate, as some- 
times happens, a sore is formed that is very difficult 
to cure, particularly if the woman is around on her 
feet. Rest, in the horizontal position, forms an im- 
portant part of the treatment ; a laced stocking, or 
a bandage, should be applied, commencing low down 
on the limb, where the veins are unaffected, and 
continuing it up the thigh ; the bowels should be 
kept in a soluble condition by gentle aperients ; 
the bandage should be applied before the patient 
gets up, as the veins are usually less distended at this 
time ; some cases will require bleeding from the 
arm ; if there is inflammation about the limb, apply 
leeches, fomentations and cold lotions ; when he- 
morrhage takes place from the veins, apply pressure 
with a compress and bandage ; also cold astringent 
lotions are sometimes of benefit. When the veins 
about the neck of the womb or labia are greatly 
enlarged, they cause more or less inconvenience at 
delivery. The applications of the galvanic bat- 



THIRTY YEAHS OF FEMALE LIFE. 225 

tery have been followed, in some cases, by a favor- 
able result. 

Swelling of the Feet and Legs. — Pregnant 
women are sometimes afflicted with a swelling of 
the feet and legs, and a more or less dropsical con- 
dition of other portions of the system, occurring 
usually during the latter part of the term ; and when 
confined to the feet and legs only, the patient does 
not experience much inconvenience from it ; but ' 
when more extensive, affecting the thighs, external 
organs of generation, and other portions of the 
body, there is considerable distress, and the patient 
is liable to convulsions, when delivery takes place. 
As it does not often occur until the womb has at- 
tained a considerable size, it is supposed to be 
caused, to a great extent, by the pressure of this 
organ upon the blood-vessels and lymphatics within 
the pelvis. The same condition is observed fre- 
quently in chlorosis, and other conditions of the 
system, characterized by an altered or impoverish- 
ed condition of the circulating fluids ; as to its man- 
ifesting itself first in the feet and legs, this is what 
might be expected, from our knowledge of the law 
of gravity, and as the patient assumes the recum- 
bent posture, the infiltrated fluid recedes, being 
scarcely perceptible in the morning, but after being 
on her feet for a few hours, it again returns. 

In some cases, the feet and legs are greatly dis- 
tended ; by pressing them with the point of the 
fingers, deep indentations are made, which gradually 
fill up, after the pressure is removed. Sometimes 



226 THIRTY YEARS OF FEMALE LIFE. 

the skin bursts, the fluid oozing out of the openings 
thus formed ; they may be attacked with erysipelas, 
followed, in some cases, with ulceration. If the 
swelling is only moderate, little inconvenience is 
experienced, but when it extends to the thighs and 
hips, the patient is obliged to confine herself to the 
recumbent posture, being unable, in some cases, to 
stand or sit without great distress. By being de- 
prived of exercise, the general health suffers in 
consequence, to a greater or less extent ; at the 
same time other portions of the body become in- 
filtrated with the fluid, which adds to the distress. 
The treatment will be modified according to the 
severity of the complaint ; the legs should be ban- 
daged as in enlarged veins, the general health im- 
proved by tonics, some of the preparations of 
iron and others ; the bowels should be kept in a 
soluble condition by saline aperients ; remedies to 
act on the kidneys and increase the quantity of 
the urine, which is often deficient,will be of service, 
for this purpose, give spirits of nitre, digitalis, 
squills, and others of this class. Some cases may 
require general bleeding ; small doses of tartar emetic 
have been used with advantage ; also friction, or blis- 
ters to the inside of the thighs. The external parts 
may be greatly distended ; sometimes they burst or 
become ulcerated, and in some cases they are so 
enlarged as to interfere with the delivery; the 
parts should be frequently bathed with lead water, 
or a decoction of poppies and sugar of lead, or some 
other stimulating or astringent wash ; or fomenta; 



THIRTY YEARS OP FEMALE LIFE. 227 

tions may be used with advantage ; hops or camomile 
flowers answer a good purpose. 

In some cases, the complaint assumes the form 
of general dropsy, or there may be a collection 
of fluid in the abdomen or chest, causing more 
or less interferance with the action of the heart and 
lungs, greatly increasing the distress and danger of 
the patient. 

Milk in the Breasts. — As an indication of preg- 
nancy, this is a sign of considerable importance, in 
most cases, yet it frequently exists under other con- 
ditions of the system. Dr. Montgomery mentions 
cases of this character. One was a girl of twenty 
years, whose breasts contained milk from the time 
she was sixteen years old, when menstruation com- 
menced ; she still continued to be regular. Another 
case was that of a married lady, who, six months 
after marriage, observed her breasts enlarge, the 
nipples become more prominent, the dark circle 
around the nipples distinctly visible, and the breasts 
contained milk. She also had other symptoms of 
pregnancy, as morning sickness, the abdomen en- 
larged, and she thought that she could feel the mo- 
tion of the child. The monthly flow was not so free 
as natural, but regular as to time. She was not 
pregnant, Baudelocque states that he saw a girl, 
only eight years old, who had a copious supply of 
milk in her breasts, caused, it is said, by an infant 
her mother was nursing, the girl allowing the child 
to nurse her. Belloc mentions a similar case ; that 
of a servant girl, who had an infant sleeping with 



228 THIRTY YEARS OF FEMALE LIFE. 

her, that was being weaned ; to quiet the child, the 
girl gave it her breast, which in a short time in- 
duced a free supply of milk. 

It sometimes happens, that a woman may have 
milk in her breasts for a number of years. Dr. 
Dewees relates an instance which came imder his 
observation. The lady had been several years mar- 
ried, but never pregnant. She had been separated 
from her husband two years, and finding milk in her 
breasts, she mentioned the unusual circumstance to 
a female friend, who, thinking that it was an indi- 
cation that the lady was pregnant, told it in confi- 
dence to her friend ; thus it went from one to an- 
other, until, at last, the brother of the lady heard 
of it ; he was greatly enraged, and charged his sis- 
ter with incontinence ; knowing herself to be inno- 
cent, she sent for Dr. Dewees to clear up the mys- 
tery, who, after an examination, declared the suspi- 
cion false ; the lady was not pregnant ; menstruation 
was suppressed, and she died a few months after of 
consumption. 

A case of this description is related by Semple, 
in the North of England Medical and Surgical 
Journal^ volume 1st, page 230. A woman, the 
mother of nine children, the youngest twelve years 
old, took the infant of her daughter-in-law, who died 
about two weeks after giving birth to the child ; 
to quiet the child, which was very fretful, the wo- 
man gave it her nipple to suck ; in a day or two, 
her breasts became painful, increased in size, and 
soon after, she found they contained milk in suffi- 



THIRTY YEARS OF FEMALE LIFE. 229 

cient quantity to satisfy the child, which she con- 
tinued to nurse. Dr. Kennedy makes mention of a 
woman, who had milk in her breasts for forty-seven 
years after the birth of her first child, and during 
that time nursed six children of her own, and eight 
others. She menstruated while nursing, and when 
eighty-one years old, the breast still contained a mo- 
derate quantity of milk. 

It is quite common to observe the breasts of fe- 
male, and also of male children, distended with a 
milky secretion immediately after birth; and cases 
are occasionally met with of men, whose breasts se- 
creted milk, bearing a close resemblance to that of 
females. Many, no doubt, have heard the story of 
the Indian, who on the death of his squaw in child- 
birth, acted as wet nurse for the little pappoose, 
and succeeded as well, apparently, as though fitted 
by nature for this office. Other cases are recorded 
and well authenticated too, of the male breasts se- 
creting this fluid ; it follows, therefore, that we 
should not be surprised to find the female breasts 
performing this function independent of pregnancy. 
With some women, the milk does not dry up 
after weaning the child. Dr. Montgomery states, 
that he has met with several instances of this 
kind, and refers to a patient that nursed her child 
for fifteen months, who retained the milk in her 
breasts in such quantity, for three years, that she 
was obliged to protect her dress from being wet 
with it, and for two years after they still contained 
a little. She menstruated regularly, but did not be- 



230 THIRTY YEABS OP FEMALE LIFE. 

come pregnant. The case of a Swedish lady, who 
had milk in her breasts for a number of years after 
weaning her child, is mentioned by Dubois ; men- 
struation did not take place during the time ; at 
length a slight show came on, soon after which, she 
became pregnant ; after having weaned the second 
child, the same peculiarity was observed again. At 
the change of life, some women experience more or 
less enlargement of the breasts, with secretion of 
milk, which leads them to think that they have be- 
come pregnant. 

Salivation. — During pregnancy, the salivary 
glands frequently become stimulated to an increased 
action ; in some cases, the woman merely spits 
more than usual, at other times it becomes excessive 
in quantity, and of an acid, irritating quality, pro- 
ducing, in some cases, great prostration. It diiBfers 
from salivation caused by mercury, in not producing 
that soreness of the gums, or peculiar odor, observed 
when that drug has been taken in sufficient quanti- 
ty to affect the salivary glands, for which it has 
sometimes been mistaken. 

" It almost always has an unpleasant taste, though 
not attended with an offensive smell ; it keeps the 
stomach in a state of constant irritation, and not un- 
frequently provokes puking, especially if the saliva 
be tenacious, and requires an effort to discharge it. 
At night it is often very troublesome, interrupting 
sleep by the frequency of the necessity of emptying 
themouth."^ 

♦ Deweeg' Midwifery, page 115. 



THIRTY YEARS OF FEMALE LIFE. 231 

It usually commences about the third month, and 
ceases soon after quickening ; in some cases, it con- 
tinues all through the term. In mild cases, rinsing 
the mouth frequently with cold water, lime water, 
or camomile tea, will be sufficient, but when very 
abundant, more active treatment will be required ; 
the bowels should be kept open with gentle laxa- 
tives, as the extract of butternut, rhubarb, or mag- 
nesia ; chalk mixture, soda or charcoal do good in 
some cases ; also a few drops of laudanum. A blis- 
ter to the back of the neck, or leeches to the angle 
of the jaws ; gargles of green tea, decoction of oak 
bark, alum, borax, or spirits of turpentine in a solu- 
tion of gum arable, or slippery elm bark, have been 
used, and frequently without much benefit, as the 
complaint often resists all treatment, yielding only 
to delivery ; yet some cases are relieved by them, 
they are therefore worth trying. 

Pain in the Side. — ^Pregnant women sometimes 
complain of a pain in the side, in the region of 
the lower ribs, caused by the enlarged womb. In 
some cases, the pain is confined to the right side, 
and proceeds from the liver, caused by the womb 
being turned to that side, and pressing on the liver. 
As the complaint does not usually commence until, 
the middle or latter part of the term, and is reliev- 
ed by child-birth, it had better be left to nature 
unless the distress is very great ; in which case, a 
mustard plaster may be applied to the seat of the 
pain, or a blister ; leeches sometimes do good, also 
general bleeding. A broad bandage applied mod- 



232 THIRTY YEARS OF FEMALE LIFE. 

erately tight around the body, will sometimes give 
relief; also, frictions Avith camphorated oil and 
laudanum. Medicine to act on the liver will be in- 
dicated, particularly if the pain is more or less 
constant in the right side ; by lying on the opposite 
side, the distress is often relieved. In some cases, 
however, it continues, in spite of treatment, until 
delivery. 

Jaundice. — A yellowness of the skin is sometimes 
observed during pregnancy : when it occurs in the 
early part of the term, from sympathetic action, it usu- 
ally passes off in a few weeks ; but when it comes on 
during the latter part of pregnancy, it is generally 
caused by the enlarged womb pressing upon the 
liver, preventing the bile from escaping ; being ab- 
sorbed, it enters the circulation, and a portion of it 
passing off through the pores of the skin, produces 
the peculiar tinge called jaundice. It shows itself 
in the yellow color imparted to the eyes, in the 
perspiration, and in the urine, which is often reduc- 
ed in quantity. The evacuations from the bowels 
are frequently of a pale, unnatural color. The pa- 
tient complains of feeling dull, inactive and sleepy ; 
and in some cases, of a soreness, on pressure, under 
the ribs on the right side. Jaundice usually passes 
off soon after delivery, producing little inconveni- 
ence, and without any special treatment being re- 
quired, more than attention to the diet, exercise in 
the open air, and regulation of the bowels. In 
other cases, however, more active treatment 'will 
be required, as calomel or blue pill, in small doses, 



THIRTY YEARS OF FEMALE LIFE. 233 

frequently repeated ; podophyllin and leptandrin ; 
leeches, or blisters to the side ; the nitro-muriatic 
acid solution applied to the region of the liver, and 
bathing the feet and legs in the same, will be found 
a valuable remedy ; or the following, extract of dan- 
delion two drachms, extract of bitter root two 
scruples, extract of golden seal one scruple, divide 
into twelve portions, one, three times a day. If 
the patient is of a plethoric or full habit, bleeding 
from the arm will be of service. 

Discoloration of the Skin. — During pregnancy 
the skin is sometimes discolored by patches of a dark 
yellow or brownish hue ; they are usually confined 
to the face, around the mouth, on the cheeks or fore- 
head; sometimes they are also observed on the 
neck and other portions of the body ; some females 
become very much disfigured by them. Delivery 
seems to be the only remedy for them, as they usu- 
ally disappear soon after child-birth ; with some 
women, they never disappear entirely ; after a time, 
however, they become very faint, scarcely percep- 
tible. When they depend upon a derangement of 
the digestive organs, independent of pregnancy, or 
a torpid, inactive condition of the liver, which is 
sometimes the case, by restoring the digestive func- 
tion, and rousing up the liver to healthy action, the 
discoloration will usually disappear in a short time. 

Toothache. — This is an early symptom of preg- 
nancy with some women, depending upon that 
mysterious sympathy, between the womb and gen- 
eral nervous system, so often observed in the female 



234 THIETY YEARS OF FEMALE LIFE. 

organism. The pain is not always confined to one 
particular tooth ; it often extends along the jaw or 
side of the face ; the patient being unable to tell 
which tooth it is that aches ; neither is the pain con- 
fined to decayed teeth, as it sometimes affects those 
that are perfectly sound, assuming, in some cases, a 
decided neuralgic character. Sometimes the essen- 
tial oils do good, as oil of cloves, and others of this 
class ; also fomentations with hot herbs, holding 
some spirituous liquor in the mouth, as brandy, 
spirits of camphor, or laudanum ; creosote relieves 
some cases ; a blister to the back of the neck, or 
leeches to the gums, has been recommended ; but 
it often resists every remedy, disappearing sponta- 
neously, in most cases, about the middle of the 
term. If a tooth is extracted, little benefit is de- 
rived, particulariy if a number of teeth are affect- 
ed ; but when the pain is confined to one or two 
teeth, and they are decayed, relief is sometimes ob- 
tained by removing them. Dr. Burns objects to 
this course, as it is sometimes followed, he says, by 
abortion ; and Dr. Blundell is opposed to extracting* 
on the ground that the pain is neuralgic. When 
the pain is of this character, hartshorn, compound 
spirits of lavender, or the ammoniated tincture of 
valerian will be of service. 

Palpitation of the Heart. — This distressing 
affection is frequently observed during pregnancy ; 
those who have been previously subject to it, also 
weakly, nervous women, are more liable to palpita- 
tion than others, and females of a full habit some- 



THIRTY YEARS OF FEMALE LIFE. 235 

times suffer from this malady. It may come on at 
any time, during pregnancy, from the slightest 
causes, or without any apparent cause ; making its 
attack, in some cases, a number of times through 
the day, or at night, soon after retiring to rest ; 
sometimes it comes on when the patient is asleep, 
from which she starts up in great distress ; at other 
times it comes on immediately after going up a 
flight of stairs, or when she is walking. If the 
patient is of a full habit, bleeding will be of service ; 
in cases where this is contra-indicated, anti-spas- 
modics, narcotics, and also tonics, will be required ; 
while the attack continues, the patient should have 
free access to pure air ; and a dose of hartshorn, 
spirits of lavender, tincture of valerian, sulphuric 
ether, or camphor should be given, and repeated as 
occasion may require ; and to prevent a return of 
the attack, some of the above remedies, or others 
of this class, may be continued ; opium, morphine 
or digitalis has a good effect, in some cases ; 
some preparation of iron, quinine, and other tonics, 
are sometimes indicated. A cloth wet with lauda- 
num and spirits of camphor, applied over the region 
of the heart, will be of service in some cases ; or 
an anodyne plaster, or a mustard plaster, may be 
substituted for the cloth ; rubbing the spine with a 
stimulating liniment, is useful is some cases ; the 
diet should be light, unstimulating, and easy of di- 
gestion ; high seasoned food and spices should be 
avoided ; the state of the bowels require particular 
attention. Women are often troubled with a flut- 



236 THIRTY YEARS OF FEMALE LIFE. 

tering of the heart, and imagine that they are af- 
fected with some serious disease of that organ. It 
is a nervous affection, for which the ammoniated 
tincture of valerian, or pills of assafoetida, or some 
preparation of iron, will usually give relief. 

rAiNTiNG. — Some women are subject to a feeling 
of faintness, or actual fainting when pregnant, that 
are free from it at other times ; it may come on at 
any time during pregnancy, but is more fre- 
quently met with during the early stages, or at the 
time of quickening. It sometimes attacks those 
that are in otherwise good health; but women of a 
weakly or nervous constitution, are the ones most 
subject to it, occurring, it may be, several times a 
day, or periodically, a number of days or weeks in- 
tervening. "When the attack is complete, respira- 
tion is nearly suspended ; the heart movements, 
and pulse at the wrist can scarcely be perceived, 
and in some cases, the circulation seems to be en- 
tirely suspended for a few minutes ; the face is pale 
and bloodless, the lips blanched, a cold, clammy 
perspiration covers the surface of the body, the 
muscles are relaxed, with a loss of consciousness. 
This species of apparent death, is sometimes pre- 
ceded by sickness of the stomach, ringing noise in 
the ears, dimness of sight, yawning, sighing, and 
great prostration of strength ; as the vital functions 
are gradually resumed, the patient is often seized 
with vomiting ; it seldom terminates fatally to the 
mother, but if the attacks are often repeated, and 
of long duration, death of the foetus may result, fol- 



THIRTY YEARS OF FEMLAE LIFE. 237 

«• 

lowed by abortion. When fainting occurs during 
child-birth, it is often a serious malady, putting the 
life of both mother and child in great jeopordy. 
Some women experience an attack of fainting from 
the vigorous motion of the child in utero ; it is also 
caused by strong mental emotions, loss of sleep, over 
exertion, standing too long on the feet, the sight of 
unpleasant objects, the odor of certain plants, or 
cooked meats, or derangement of the stomach and 
bowels ; it is frequently observed in females whose 
nervous system has been weakened by the whites, 
and other debilitating discharges, and also by the 
changes produced in the system by pregnancy. It 
is often associated with palpitation of the heart. 
During the attack, the treatment indicated does not 
differ materially from that recommended under the 
head of hysteria, and as fainting usually occurs in 
females, presenting peculiarities of constitution 
similar to those subject to attacks of hysteria, and 
is often induced by like causes ; the remedies calcu- 
lated to prevent a return of the paroxysm in the 
latter complaint, will be of service in the former. 
Tonics will, therefore, form an important part of the 
treatment, together with anti-spasmodics, strict at- 
tention to the diet, and regulation of the bowels. 

Difficulty of Breathing. — Women are often 
troubled with a difficulty of breathing, at some pe- 
riod of pregnancy, and by some authors, it is divi- 
ded into three varieties. The first, occurring during 
the first three or four months, is of a nervous char- 
acter, and arises from a sympathetic action with the 



238 THIRTY TEARS OP FEMALE LIFE, 

impregnated womb, and produces little constitution- 
al effect. The ammoniated tincture of valerian, 
spirits of lavender, camphor and hyoscyamus, and 
other remedies of this class, will usually relieve 
this form of the complaint ; or, as pregnancy ad- 
vances, it frequently disappears spontaneously. 
The second variety comes on about the fifth month, 
and is attended with considerable disturbance of 
the system ; the patient complains of pain in the 
head, the face is flushed, the temples throb, the 
head is hot, with a feeling of heaviness and confu- 
sion of ideas ; the patient is dull or drowsy, at 
times during the day, and at night, talks in her 
sleep, or starts up, as in a fright, and has frightful 
dreams. Those subject to this form of the com- 
plaint, are usually of a plethoric or full habit, and 
require bleeding to relieve the over distended ves- 
sels, and equalize the circulation ; *at the same time 
the bowels should be kept quite free by laxatives 
or active purgatives, which will be sufficient to re- 
lieve the distress in some cases, without bleeding ; 
the diet should be unstimulating, and the patient 
should avoid spices, and high seasoned food. The 
third form of this complaint is due to the enlarged 
womb pushing up the diaphragm, thereby reducing 
the size of the chest and interfering with respira- 
tion, and consequently is observed towards the end 
of pregnancy. It is of more frequent occurrence 
in women with their first child than others, in con- 
sequence of the abdominal muscles offering a great- 
er resistance to the enlargement of the womb, in 



THIRTY YEARS OF FEMALE LIFE. 239 

the first pregnancy, than is observed in subsequent 
ones. At first, the muscular tissue, in many cases, 
forces the womb to enlarge in an upward direction, 
but in repeated pregnancies, the muscles become 
weakened, and do not ofier that resistance as at first; 
the womb therefore increases more in breadth, and 
less in length, which gives freedom to the respira- 
tory movements. In treating the third variety of 
this complaint, bleeding may be of service, in some 
cases ; the bowels should also be kept in a soluble 
condition, and the patient should be advised to 
take but little food at a time, to avoid distending 
the stomach as much as possible, which will be 
some relief; she can eat a little at a time and 
often, so as not to suffer in this respect. She should 
also assume a position that would afford her the 
the most relief; some are obliged to remain in 
nearly an upright position, supported with cushions, 
others find more relief on their knees and elbows. 
As this complaint comes on near the termination of 
pregnancy, in most cases, we must look to delivery 
for a cure ; for more than a slight mitigation is sel- 
dom attained from any course that might be recom- 
mended ; and in cases where the distress is very 
great, it may sometimes be advisable to hasten this 
event, by inducing premature delivery, the child 
being viable, which of course is to be expected, as 
the difficulty does not come on before this time. 
This form of difficulty of breathing, is also observed 
in females who have some malformation, or deformi- 
ty of the pelvis ; in which case, the propriety of 



240 THIRTY YEARS OF FEMALE LIFE. 

bringing on premature delivery should be earlier 
taken into consideration. Difficulty of breathing is 
sometimes caused by inhaling certain odors. In re- 
gard to this circumstance, Dr. Churchill remarks, as 
follows ; — " A curious variety of the disease, de- 
pending upon this cause, has received the name of 
hay fever. This occurs during the summer, from 
the perfume of new hay. The patient may be 
quite free from the disease in town, but whenever 
she drives into the country, and inhales the rich 
odor of the newly mown grass, the dispncea comes 
on, and is only relieved by removing to a distance 
from the cause.'^* 

Cough. — ^Pregnant women are often afflicted with 
a very troublesome cough. In some cases, a little 
fluid is expectorated ; more frequently, however, it 
is a dry, hacking cough. When it occurs during 
the early period of pregnancy, it is due to sympa- 
thetic action ; in other cases, it does not come on 
until the womb has attained a considerable size ; it 
is then caused, as in the previous complaint, by the 
enlarged womb pressing upon the vital organs with- 
in the chest, which produces an irritation ; it 
usually ceases with delivery. In some cases, the 
cough comes on in such violent paroxysms that 
abortion takes place ; it is, therefore, necessary to 
mitigate, as far as possible, the severity of the at- 
tack. Tincture of valerian, and other anti-spasmodics 
will sometimes be of service in that variety of 
cough arising from sympathetic action ; also expec- 

* Churchill on Diseases of Women, page 478. 



THIRTY YEARS OF FEMALE LIFE. 241 

torants and narcotics, as Dover powder, or hyoscya- 
mus, hive syrup, or the following : — syrup of squills 
and syrup of senega, of each one ounce, tincture of 
sanguinaria and tincture of balsam of tolu, of each 
half an ounce ; mixed, Dose^ half a tea-spoon, or a 
tea-spoonful, three or four times a day ; or a few 
drops may be taken frequently, as the cough is 
troublesome. A blister, mustard plaster, or a Bur- 
gundy pitch plaster, on the spine, between the 
shoulders, will sometimes be of service ; bleeding 
may be required where there is more or less con- 
stant headache ; cathartics, also, have a beneficial 
effect. When it occurs from the effect of pressure 
from the enlarged womb, bleeding is usually indica- 
ted more frequently than in the preceding variety, 
and the bowels should be kept open by saline ape- 
rients, and some of the above remedies may be re- 
sorted to ; also the following : — spirits of mindera- 
ra, one ounce, spirits of nitre, half an ounce, tincture 
of digitalis, one drachm. Dose^ one or two tea- 
spoonsful, three or four times a day, in a little water. 
It is often the case, that nothing more than tempo- 
rary relief can be accomplished by any course of 
treatment, as it frequently continues until child- 
birth, at which time it usually ceases. 

Headache. — This troublesome malady is often 
observed during pregnancy, and may occur at any 
time during the term ; in some cases, it is of a ner- 
vous character, in others, it is evidently from over 
distension or engorgement of the blood-vessels. 
The nervous headache occurring in the early period 



242 THIRTY YEARS OF FEMALE LIFE. 

of pregnancy, is probably due to sympathetic ac- 
tion, and usually passes oflf as pregnancy advances. 
Sometimes it is periodic in its character, coming on 
at certain times every day, or every one or two 
days, and ceasing after a few hours. In such cases, 
tonics are indicated, as the bitter infusions, tincture 
of Peruvian bark, quinine and iron. The nervous 
headache will be relieved, usually, by tincture of va- 
lerian, spirits of lavender, camphor and the like ; 
opium, laudanum, morphine or hyoscyamus may be 
required in some cases. When associated with con- 
stipation, opening medicines will be of service. 

The other variety of headache to which preg- 
nant women are sometimes subject, occurs about 
the middle or latter part of the term, and is caused 
principally, by the pressure of the womb on the 
blood-vessels within the cavity of the abdomen, 
which prevents a free circulation from the upper 
to the lower extremities ; the vessels of the upper 
portion of the body are thus over loaded or conges- 
ted, which is manifested by a greater fullness of 
the vessels of the face and head, throbbing of the 
the temples, flushings of the face, pain in the head^ 
sometimes confined to one particular spot, as in the 
top or back part of the head, over one eye, or 
through the temples. In some cases, the patient 
complains of dizziness, ringing in the ears, and if 
she stoops to pick up a pin from the floor, as soon 
as she rises to the erect posture again, every thing 
turns dark to her, a kind of film or mist coming 
before the eyes. The tongue is often foul, with a 



THIRTY YEARS OF FEMALE LIFE. 243 

bad, bitterish taste in the mouth, particularly in 
the morning ; appetite variable, bowels irreuglar, 
pulse quick and strong, the eyes more or less affect- 
ed with light and feel sore when moved around in 
the sockets. *' Headache,^' says Dr. Burns, '' is a 
very alarming symptom, when it is severe, constant, 
and accompanied with symptoms of plethora. If 
the eye be dull or suffused, and the head giddy, 
especially when the patient stoops or lies down, 
with a sense of heaviness over the eyes or within 
the skull, great danger is to be apprehended, par- 
ticularly if she be far advanced in her pregnancy. 
This is still more the case, if she complain of ring- 
ing in the ears, and see flashes of fire, or have in- 
distinct vision. I am pretty well satisfied, that, in 
most cases, although the head be pained, yet the 
spinal cord is the part originally diseased, and the 
head only suffers in a secondary way. In some in- 
stances, there is a fixed pain in one part of the 
back, along with, or preceding the affection of tho 
head."^ 

The treatment consists in relieving the over dis- 
tended vessels, by bleeding from the arm, leeches 
to the temples, cold application on the head, and 
purgatives ; the bowels having been opened by an 
active cathartic, they should be kept a little loose 
by saline aperients. A blister to the back of the neck 
or friction along the spine, is of service in some cases ; 
stimulating food or drinks should be avoided, and 
exercise in the open air recommended. Females 

♦Burn's Midwifery, page 185. 



244 THIRTY YEARS OF FEMALE LIFE. 

of all ages and conditions in life, are frequently 
subject to headache, whether pregnant or not, at- 
tended, in many cases, with faintness, nausea, and 
vomiting. This form is commonly called sick head- 
ache, and commences in the morning more frequent- 
ly than at any other time ; the pain, in many cases, 
shifting about from one part of the head to another. 
Persons subject to sick headache are frequently 
more or less dyspeptic, and in many cases, the bow- 
els are constipated, and the liver in a torpid condi- 
tion. The remedies recommended for nervous head- 
ache, will sometimes do good in this form of the 
complaint, also mint tea, or a few drops of the es- 
sence of, pepperment and water ; one or two drops 
of creosote in a table-spoonful of sweetened water ; 
or chloroform, three or four drops in a little water 
or flax seed tea ; it should be mixed with the water 
by shaking or stirring just before being taken, as the 
chloroform soon settles by standing. In some cases of 
sick headache, seidlitz powders give great relief, also 
the chalk mixture, magnesia, ammonia, carbonate of 
soda, or eight or ten drops of liquor potassa, in a 
wine glass of water three or four times a day. 
Subnitrate of bismuth five or six grains, made into 
pill, wuth extract of gentian or dandelion, three or 
four times a day, produces favorable results in 
some cases ; also camomile flowers, columbo, tinc- 
ture of Peruvian bark, and others of this class. 
To act on the liver, small doses of calomel, blue pill, 
podophyllin and leptandrin, extract of dandelion 
or a tea made by steeping the roots of the plant in 



THIRTY YEARS OP FEMALE LIFE. 245 

water. In some cases acids do good, as one or two 
tea-spoonsful of vinegar in a wine glass of water ; 
ten or twelve drops of elixir of vitriol, or four or 
five drops of nitro muriatic acid, in a wine glass of 
water three or four times a day. Particular atten- 
tion should be paid to the bowels ; a costive habit 
should be corrected by dieting, or gentle laxatives. 



CHAPTER XXIV. 

DURATION OF PREGNANCY. 

The time when women are the most liable to 
become pregnant, is subject to no definite rule, as 
some most readily conceive immediately after the 
monthly period ceases, and others just before it 
commences, or at any time during the intermission ; 
and it has been known to occur from intercourse 
during the flow. The general opinion seems to be, 
that in most cases, conception is more likely to oc- 
cur a few days after the show ceases, than at any 
other time, and acting on this opinion, women 
sometimes refrain from sexual intercourse during 
the first twelve or fourteen daj^s after menstruating, 
for the purpose of preventing pregnancy ; but it is 
evident such a course would seldom succeed as an- 
ticipated, for, by calculating back from the com- 
mencement of labor to the time of conception, al- 
lowing the usual number of davs for the Deriod of 



246 THIRTY YEARS OF FEMALE LIFE. 

gestation, in a large number of cases we shall find 
that impregnation is just about as likely to occur 
one time between the periods as another. If there 
is any time more favorable than another for pregnan- 
cy to take place, it is just before or immediately 
after the show commences or ceases. 

After conception has occurred, women usually 
fall in labor at the expiration of forty weeks, or 
two hundred and eighty days ; ten lunar months, or 
nine calender months and one week. It is usual 
for women when calculating the time of their con- 
finement, to date from a fortnight after the last ap- 
pearance of menstruation ; also from the time of 
quickening ; some date from the time the show 
ought to come on, and in occasional instances, the 
woman calculates from sensations experienced at 
the time of intercourse, which they never have 
only when they conceive. Dr. Merriman says, 
" when I have been requested to calculate the time 
at which the accession of labor might be expected, 
I have been very exact in ascertaining the last day 
on which any appearance of the catamenia was 
distinguishable, and having reckoned forty weeks 
from this day, assuming that the two hundred and 
eightieth day from the last period was to be consid- 
ered as the legitimate day of parturition.^' 

Although the common mode of calculating the 
duration of pregnancy is often correct, it is also 
frequently wrong, and this is no more than could be 
expected in a matter where there is seldom any 
means of obtaining correct data to start from ; but 



THIRTY YEARS OF FEMALE LIFE. 247 

when conception takes place from a single coitus, 
the duration of pregnancy can be calculated with 
certainty. Montgomery and others relate cases of 
this description, where the husband having been 
absent for a length of time, returns on a certain 
day and takes his departure on the next, pregnan- 
cy happening from this short visit. Some women 
conceive that do not menstruate, and even after they 
have ceased to menstruate for a year or two ; and 
others, again, irregular in their periods, become 
pregnant. Such cases render the date of concep. 
tion very obscure, and the same may be said in re- 
gard to quickening ; with many women this takes 
place at or near the fourth month. Dr. Montgom- 
ery states, according to his experience, quickening 
occurs from the twelfth to the sixteenth week, or 
between the fourteenth and eighteenth week after 
the last menstrual period. But the period of quick- 
ening is liable to great variation ; cases are men- 
tioned by the author just referred to, and others, 
where it has occurred about the tenth week, and in 
other cases not till the sixth or seventh month, and 
some women may not feel the motion of the child 
during the whole term, yet it may be born alive 
and vigorous. Cases frequently occur, where the 
woman believes herself pregnant, and feels what 
she considers the motion of the child when she was 
not pregnant. 

" A mistake of this kind," says Dr. Montgomery^ 
" is seriously interwoven with the history of Eng- 
land, as having occurred in the person of Queen 



248 THIRTY YEARS OF FEMALE LIFE. 

Mary, who was so certain of having felt the child 
stir in her womb, that dispatches were sent to in- 
form foreign courts of the joyful event ; but it 
turned out to be only the effects of bad health, and 
the commencement of a dropsy ■ which disappoint- 
ment, conjoined with other annoyances of a domes- 
tic nature, so irritated the queen, that she totally 
lost her temper, and was guilty of some disgraceful 
acts of unjustifiable severity." 

Hume says, '' Her infant proved only the com- 
mencement of a dropsy, which the disordered state 
of her health had brought on.'^"^ 

A woman, laboring under such a delusion, is often 
very tenacious of her opinion, and should she apply 
to a physician in the matter, he would get little 
credit for his sagacity, should he give a contrary 
opinion ; and in some cases, little credit would be 
due him, for he, too, is liable to be led into error by 
some condition of the system, which simulates preg- 
nancy, and particularly in those occasional cases, 
where, from the movement of wind in the bowels, 
or peculiar contractions of the abdominal muscles, 
the movements of the child are very closely 
simulated. 

Dr. Dewees mentions the case of a young lady, 
who had symptoms of pregnancy, and while exam- 
ining the abdomen, he thought he could feel the 
motions of the child. She was not pregnant, but 
the womb was enlarged from an accumulation of 
menstrual fluid ; similar cases are related by Mont- 

* Hume's History of England, chapter 36. 



THIBTY YEARS OF FEMALE LIFE. 249 

gomery, and others. Sometimes the physician is 
led into error by the wilful deception of the female 
herself; as some have been known to possess the 
power of enlarging the abdomen at will, in such a 
way, as to resemble the impregnated womb, if ex- 
amined externally, and also of contracting the ab- 
dominal muscles, so as to resemble the motions of 
the child. Dr. Blundell mentions a case of this de- 
scription, and Dr. Reece relates the same in regard 
to the virgin prophetess, Johanna Southcott, who, 
at the age of sixty-four, pretended she was im- 
pregnated by spiritual agency. This wily impostor 
could imitate the motions of the child with such 
precision, and having an enlargement of the 
abdomen, a number of physicians who examined 
her, really believed she was pregnant. Death put 
an end to her imposition, and the examination which 
followed, revealed the fact, that she had not been 
pregnant ; but no tumor could be found that had 
been previously supposed to exist. It occasionally 
happens, that the motions of the child cease to be 
perceptible, after having been distinctly felt for a 
time. This suspension may last for a month, and 
again take place ; or it may continue during the 
rest of the term, and the woman be finally delivered 
of a living child, in no way affected by the suspen- 
sion ; cases of this kind are mentioned by Dr. Mont- 
gomery, and others. As previously stated, the usu- 
al duration of pregnancy is two hundred and eighty 
days, yet it is sometimes protracted beyond this 
period. 



250 THIRTY YEARS OF FEMALE LIFE. 

Dr. Wm. Hunter says, " The usual period is nine 
calendar months, but there is, very commonly, a dif- 
ference of one, two or three weeks. I have known a 
woman bear a living child in a perfectly natural 
way, fourteen days later than nine calendar months, 
and believe two women to have been delivered of a 
child alive, in a natural way, above ten calendar 
months from the hour of conception f and Dr. De- 
wees mentions the case of a lady, " who was not de- 
livered for full ten months after her husband's 
departure for Europe ; yet so well, and so justly too, 
did this lady stand in public estimation, that there 
did not attach the slightest suspicion of a sinister 
cause." 

Dr. Burns says " how long it is possible for labor 
to be delayed beyond the usual time cannot easily 
be ascertained ; but it is very seldom protracted 
beyond a few days, counting the commencement of 
pregnancy from the day preceding that on which 
the menses ought to have appeared, had the woman 
not conceived. The longest term I have met with, 
is ten calender months and ten days, dated from the 
last menstruation.""^ 

In this case, the regular menstrual period was 
five weeks. 

The decision in the Gardner Peerage case, that 
excited so much interest in England, was not against 
the legitimacy of the contestant, who was born 
three hundred and twelve days after the departure 
of Lord Gardner, but, as Dr. Montgomery says, 

* Burns' Midwifery, page 143, 



THIRTY YEARSOF FEMLAE LIFE. 251 

'* It was the adultery of the mother, and the conceal- 
ment of the birth from the husband, which justified 
the House in refusing the petition of the counter- 
claimant. If the only point in the case, had been 
that he was not the son of Lord Gardner, because 
it was impossible his mother could have gone forty- 
four weeks with him, the House of Lords could not 
have declared him illegitimate, and when Lord 
Eldon said he should give his opinion ' without en- 
tering into the question of the ultimum tempus pa- 
rienda,' it is perfectly clear he did so for the pur- 
pose of guarding against the decision being ever 
taken as a precedent, that a gestation protracted 
four weeks beyond the usual time, should be a ground 
for bastardizing a child/^^ 

A case of protracted gestation is reported by 
Dr. Atlee, of Philadelphia, and referred to by Dr. 
Tucker, in his work on midwifery. The defendant 
was indicted for fornication and bastardy, and the 
case was tried in the Lancaster Quarter Sessions, 
Pa. The complainant swore that the child was begot- 
ten on the twenty-third of March, 1845, and born 
on the thirtieth of January 1846, making the period 
of pregnancy three hundred and thirteen days. 
The jury found the defendant guilty. 

Dr. Dewees states " that in at least four females 
that I have attended, each of these women went 
one month longer than the calculations made, from 
an allowance of ten or twelve days after the cessa- 

* Montgomery on the signs and symptoms of Pregnancy, page 449. 



252 THIRTY YEARS OF FEMALE LIFE. 

tion of the last menstrual period, and from the 
quickening, which was fixed at four months/' 

It is evident, from the above cases, and others 
referred to by several distinguished authors, that 
the usual period of pregnancy is occasionally pro- 
tracted beyond the common term by several days ; 
on the other hand, the common period may be 
abridged by the birth of a child, vigorous and live- 
ly, long before the natural term has been completed. 
The process of development being retarded, as in 
the case of protracted gestation, or abridged when 
the child is born, apparently fully developed, before 
full term. 

Viability. — The period at which a child, if born, 
is capable of maintaining a separate existence, in. 
dependent of the mother, is called viability. With 
most authors, a child is not considered viable until 
it has nearly or quite completed seven months of 
uterine life ; yet cases are mentioned by several 
distinguished authors, of children born before 
the seventh month, that survived, and ultimately 
did well. 

Dr. Wm. Hunter says, ^' a child may be born 
alive, at any time after three months ; but we see 
none born with powers of living to manhood, or of 
being reared, before seven calender months, or near 
that time. At six it cannot be.'' And Dr. Mont- 
gomery says, '' In the former edition of this book, 
I stated my belief, that the condition of viability 
was not acquired until seven months of intra-uterine 
existance were completed : my experience, at that 



THIRTY YEARS OF FEMALE LIFE. 253 

time, not having furnished me with any earlier in- 
stance under my own observation, and of the par- 
ticulars of which I had perfectly accurate know- 
ledge ; but very soon afterwards, a case occurred to 
me, which afforded unquestionable proof that a 
child, born after six months and eighteen days of 
utero gestation, may survive/'"^ 

Dr. Rodman mentions the case of a woman, the 
mother of several children, who brought forth a 
child that was supposed had not exceeded nineteen 
weeks ; it lived one year and nine moths, and when 
three Aveeks old, weighed one pound and thirteen 
ounces, and measured thirteen inches. Dr. Mont- 
gomery, who refers to the case, thinks the mother 
was mistaken in regard to the period of pregnancy 
at which the birth occurred, as the size of the child 
corresponded to a period of between six and seven 
months. Several instances are recorded of children 
born before the sixth month, which were finally 
reared, after much care and trouble, they being in 
such a feeble condition that it was necessary to 
wrap them in cotton, or other soft material, and 
keep them warm by artificial heat ; and this course 
is sometimes required with seven months children ; 
but these reputed cases of premature births before 
the sixth month, even if stated in good faith, do not 
controvert the general opinion, that viability does 
not commence until the seventh month, or near that 
time, for the simple reason, that it is a difficult ques- 
tion to decide, very often, when pregnancy commen- 

* Montgomery on Pregnancy, page 415, 



254 THIRTY YEARS OF FEMALE LIFE. 

ces ; and also the great liability to be led into error, if 
the opinion is formed from the development of the 
child. If all children attained a certain develop 
ment alike, at a certain time, the question could be 
decided without a peradventure, but we know this 
is not the case, as we frequently see a foetus of 
seven months, resemble in its development one of 
six or even five months. Some women are deliver- 
ed one or two months before full term in every 
pregnancy. Dr. Dewees states that he has known 
several instances of this kind ; in one case, it occur- 
red regularly at the seventh month ; in two others 
at the eighth month ; and Dr. Montgomery says 
that a member of his family '' never passed the end 
of the eighth month, in three successive pregnan- 
cies ; and a patient of his, who has borne five 
children, never went beyond seven months and a 
half, generally only seven, and in one instance, gave 
birth to a viable child at very little more than six 
months and a half ; but such cases cannot be looked 
on as instances of gestation completed, but of pre- 
mature labor, from some peculiarity of the system, 
or indisposition in the uterus to enlarge beyond a 
certain size ; nor is it contended or asserted by 
those writers who have recorded such cases, that 
the children had acquired their full growth ; in the 
instances occurring under my own observationi 
they certainly had not ; but under such circumstan- 
ces, we should be extremely cautious in pronounc- 
ing an opinion on the uterine age of the child ; 
particularly, when the period of gestation may 



THIRTY YEARS OF FEMALE LIFE. 255 

have advanced to Avithin a month of its expected 
termination ; in which case, it might be impossible 
for us, Avith all our care, and all our knowledge, to 
draw the distinction between a child of eight months 
and one of full maturity.'** 

Sexual Enjoyment. — The opinion was pretty- 
generally entertained at one time, that pregnancy 
could not occur unless the female experienced sex- 
ual enjoyment during the act, and this belief is en- 
tertained by some at the present day ; but there is 
abundant evidence to prove that this is not the 
case, as women frequently become pregnant, that 
never have the slightest enjoyment from intercourse, 
but, on the contrary, the act is constantly painful or 
disagreeable to them. 

In relation to this subject, Dr. Montgomery says, 
'' There is an opinion very generally entertained in 
society, and which very often meets us in practice, 
that a woman who has no sexual feeling, is necessa- 
rily barren ; now, this is quite untrue ; I have met 
with several instances of women, who were utterly 
without sexual sensibility, and yet became preg- 
nant several times. Some years ago, I was consult- 
ed about his wife, by a gentlemen, who was greatly 
dissatisfied because the lady, who was young and 
very pretty, was entirely devoid of sexual feeling. 
She afterwards told me herself, that as far as sensa- 
tion was concerned, she was not even conscious of 
the act of intercourse ; she has since had four child- 
ren. Another lady, who had a very long and other- 

♦ Montgomery on Pregnancy, page 422. 



256 THIRTY YEARS OF FEMALE LIFE. 

wise bad first labor, told me she knew the cause to 
be the dead condition of her womb ; which she ex- 
plained, by informing me that it was totally without 
sensation. About three years ago, I was consulted 
by a lady, who had been some months married, 
without conceiving ; which circumstance caused her 
husband great annoyance, and was, I believe, a sub- 
ject of much domestic unhappiness ; she told me 
that she feared it never could be otherwise, as she 
was not only totally destitute of desires, but of all 
sensation from intercourse. In this month, Februa- 
ry, 1854, she again consulted me, and told me that 
she had borne a living child, and miscarried twice 
since her former visit to me, and supposed herself 
again pregnant, but assured me that the same total 
apathy continued, just as before."^ 

That cases of this description are exceptions to 
the rule, there is no doubt, from the arrangement 
and structure of the organs ; besides, it is a law of 
Divine origin, to multiply and replenish the earth, 
and as a further inducement for the more faithful 
observance of this mandate, the Creator has wisely 
implanted certain desires, the gratification of which 
being attended with sensations peculiar to the or- 
gans concerned, the law of our being is the more 
readily complied with, than it would be, were the 
act of sexual union a matter of indifference to both 
parties ; and if it is right for the male, it is also 
right for the female to participate in the enjoyment. 

Pregnancy may also occur when the female is in- 

* Montgomery on Pregnancy, page 298. 



THIRTY YEARS OF FEMALE LIFE. 257 

sensible from drugs or strong drink, during a fit of 
hysteria, Avhile she has fainted from fright or fear, 
and during sleep. In this connexion, Dr. Gooch 
makes the following remarks : — " It is not necessary 
that the woman should be sensible at the time of 
impregnation, or that she should have pleasurable 
sensations, for some women never have, yet are very 
susceptible of impregnation. A maid at an inn, 
who was always thought to be virtuous, and bore a 
good character, began to enlarge in a way which 
excited suspicions of pregnancy ; she solemnly de- 
clared that she never had connection with any man. 
At length she was delivered, and was afterwards 
brought before a magistrate, to swear to the father ; 
but she repeated her former declaration. Not long 
afterwards, a post-boy related the following circum- 
stance : — that one night he came late to his inn 
put his horses into the stable, and went into the 
house, and found all gone to bed except this girl, 
who was lying asleep on the hearthrug, and without 
waking her, he contrived to gratify his desires. 
This shows that impregnation may take place with- 
out the knowledge of the female, or any excitation 
of sexual passion.""^ 

Dr. Montgomery mentions similar cases, and Ca- 
puron says : — " It is a fact, which experience has 
more than once confirmed, that a woman may be- 
come with child while in a state of hysteria, under 
the influence of narcotics, during asphyxia, drunk- 
enness, or deep sleep, and consequently without be- 

*Gooch's Midwifery, page 85. 



258 THIRTY YEARS OF FEMALE LIFE. 

ing conscious of it, or sharing in the enjoyment of 
the man who dishonors her." 

From numerous instances of a similar nature, rela- 
ted by accurate and reliable observers, the fact is 
established beyond question, that under certain cir- 
cumstances, a female may become pregnant without 
her knowledge. 

Delivery during Sleep. — There is, no doubt, a 
great difference in the amount of suffering experi- 
enced by different women during child-birth, but 
that a woman could be delivered of a full grown 
child during ordinary sleep, seems impossible ; yet 
however much it may be out of the usual course, 
cases are recorded, which are perfectly reliable, 
where it has occurred, even with the first child, 
which would seem less probable than where the 
female had been previously dehvered of children* 
Dr. Montgomery states that he attended a lady, not 
twenty years of age in her first confinement ; the 
labor was of about six hours duration ; a few 
minutes before the birth of the child, she fell into a 
deep sleep, from which she did not awake until 
after the delivery had occurred, the cord divided, 
and the child placed in the lap of the nurse at the 
other end of the room. The author, just referred 
to, mentions a similar case, related by Dr. Douglas ; 
in this case, the mother was awakened by her daugh- 
ter, a girl of five years, who had been sleeping with 
her for several nights. The little girl feeling the 
movements, and hearing the cries of the infant in 
the bed with her, aroused her mother, who found 



THIRTY YEARS OF FEMALE LIFE. 259 

that she had been delivered of a child without her 
knowledge. In the London Practice of Midwifery, 
it is stated, that " a lady of great respectability the 
wife of a peer of the realm, was actually delivered 
once in her sleep. She immediately awaked her 
husband, being a little alarmed at finding one more 
in the bed than was before.'' 

Delivery has been known to occur without pain, 
the woman being awake and conscious during the 
whole process. A lady in her first pregnancy, was 
delivered of twins, weighing respectively three and 
a half and four pounds, who declared that she did 
not suffer any pain. In this case, no narcotic or 
other drug had been administered to counteract 
pain. Dr. Montgomery mentions a patient of his, 
who was delivered of eight children at different 
times, without ever having labor pains. For de- 
livery to take place during ordinary sleep, or with- 
out pain when awake, the parts concerned in par- 
turition must be very much relaxed, or more easily 
dilated than is usually met with. 



260 THIRTY YEARS OF FEMALE LIFE. 



CHAPTER XXV. 

ABORTION, OR MISCARRIAGE. 

When the product of conception is expelled be- 
fore it lias arrived at the period of viability, it is 
called a miscarriage, or abortion ; after this period, 
premature labor. Abortion may occur at any period 
of pregnancy, but the greatest number takes place 
about the third month. The earlier it occcurs the 
less danger to the mother, and the longer it is post- 
poned, the less danger to the foetus. It is a common 
opinion, that a miscarriage is attended with more 
serious consequences than delivery at full term, but 
so far as the abortion is concerned, this is not the 
case, particularly if it occurs during the first two 
or three months of pregnancy, and the woman 
takes proper care of herself ; but a great many fe- 
males regard it as a matter of little consequence, 
and in a day or two after the abortion, get up and 
attend to their duties as though nothing had hap- 
pened ; the consequence is, they are often attacked 
in a few days with alarming symptoms, which fre- 
quently results in a long period of ill health, if not 
serious disease of the reproductive organs. Al- 
though not usually a serious affair, with judicious 
management, yet, abortion is an accident always to 
be deprecated and guarded against with the utmost 
care* 



THIRTY YEARS OF FEMLAE LIFE. 26l 

Causes. — The causes of abortion are many, 
and often very obscure ; they are divided usually 
into two classes ; the first have reference to the 
mother, the second to the foetus ; but it is often dif- 
ficult, if not impossible, to discriminate between 
the two, and in some cases abortion occurs without 
our being able to discover any satisfactory cause. 
An irritable condition of the womb is generally ad- 
mitted to be a prolific cause of abortion, and ope- 
rates in this way ; the presence in the womb of the 
product of conception, increases the irritability of 
the organ ; contractions are induced, and the ovum 
is expelled. A similar process is often observed in 
irritability of the bladder ; the presence of only a 
small quantity of urine in the bladder increases 
the irritability which compels the woman to pass 
water often. 

Abortion occurs in all conditions of life, but more 
frequently in the two extremes, being sometimes 
induced by a luxurious mode of living, and by want 
of proper nourishment and exposure to hardships. 
A female is more liable to abortion at a certain time 
in the month, corresponding to the period that men- 
struation would have occurred had it not been 
prevented by impregnation, and there is no doubt 
the product of conception is often lost, particularly 
at the next menstrual period, and the woman not 
be aware of the occurrence ; being so small, it 
would easily escape detection, and the symptoms 
would present little or no difi'erence from a profuse 
flow of the courses. This supposition is the more 



262 THIRTY YEARS OF FEMALE LIFE. 

probable, from the fact, that women subject to men- 
strual derangements are very liable to abortion. 
Although all females are subject to this accident, 
some seem to be more predisposed to it than others, 
particularly those of a nervous, excitable tempera- 
ment, which renders them more susceptible to 
certain influences or mental emotions, and those of 
a full plethoric habit, particularly if there is too 
great a determination of blood to the uterine 
organs. 

The different diseases of the reproductive organs, 
also, induce abortion, as leucorrhoea, misplacements 
of the womb, congestion, inflammation, ulceration, 
tumors and other abnormal conditions of the womb 
and ovaries. Among the causes may also be enu- 
merated, jumping, horse-back riding, lifting heavy 
weights, being too much on the feet, any violent 
exercise, or over exertion, reaching after some arti- 
cle in a high position, coughing, straining at stool, 
in dysentry or constipated condition of the bowels. 
Some medicines have been known to produce abor- 
tion, as active cathartics, particularly those acting 
principally on the lower bowels, as aloes and others 
of this class, also tansy, savin, penny-royal, madder^ 
the bark of the cotton-plant root, and others, pos- 
sessing similar properties. Although abortion 
sometimes results from the administration of some 
of these medicines, yet it is, by no means, certain 
to follow ; still they should not be given without 
due regard to the condition of the female. Certain 
complaints induce abortion, as syphilis, small-pox, 



THIRTY YEARS OF FEMALE LIFE. ^ 263 

typhus and scarlet fever, and others ; also general 
debility, or weakness of the uterine organs. Falls, 
blows, and other external injuries cause abortion ; 
also violent emotions of the mind, as fear, grief, an- 
ger, good or bad news, and the like. Some women 
acquire a habit of aborting ; when this is the case, 
it usually occurs about such a period each time ; in 
such cases, the female should pay strict attention to 
the stomach and bowels, avoid stimulating articles 
of diet and all excitements, and observe the recum- 
bent posture for a few days before and after the ex- 
pected time. 

From some of the causes just mentioned, or from 
some unknown cause, the vitality of the ovum is de- 
stroyed, or its development arrested, resulting in a 
premature expulsion from the womb ; this general- 
ly occurs in a few hours or a few days after the ac- 
tion of the cause ; in other cases, it may be retained 
in the womb for months, and in some rare instances, 
for years. Sometimes the ovum is expelled in a 
perfectly healthy condition ; at other times, it ex- 
hibits unmistakeable evidence of disease. It may 
be expelled entire, in small portions at a time, or 
gradually decompose, and come away as a more or 
less offensive discharge, occupying many days or 
weeks. In some cases, vitality ceases at an early 
period, and at full term, the woman is delivered of 
a blighted ovum ; or it may assume the form of a 
false conception, mole or hydatids, which are usual- 
ly expelled at, or before, the regular time of deliv- 
ery ; sometimes they are retained much longer. 



264 THIRTY YEARS OF FEMALE LIFE. 

Cases are recorded by Ambrose Par^, Velpean, and 
others, where these abnormal products of concep- 
tion have been retained in the womb many years. 

Sometimes in a twin pregnancy, one ovum dies, 
and is expelled, without interrupting the process of 
development of the other, and in due time, the wo- 
man is delivered of a healthy, full grown child ; or 
the dead ovum may be retained, and expelled with 
a living child at term. It is evident that a certain 
effect must depend upon a cause ; it is, therefore, 
quite natural, in a case of abortion^ to assign some 
cause for the accident ; but in many cases, the cause 
assigned is what all women are exposed to, more 
or less ; and were many of these causes to exert 
the same effect upon all pregnant women alike, few 
deliveries would occur at full term. It has been 
previously stated, that abortion generally occurs at 
a time previously observed as a monthly period ; to 
this periodical influence, all women are exposed, 
yet all do not abort. We are, therefore, led to be- 
lieve, that in the great majority of abortions, there 
must be some abnormal condition of the reproduc- 
tive organs, which is really the predisposing cause . 
and many of the so called causes, if exerting any 
influence at all, are merely incidental, at most, 
and not sufficient in themselves, to produce the 
effect. 

Symptoms. — The symptoms of abortion are modi- 
fied somewhat, by the period of pregnancy at which 
it occurs, by the general health, or peculiarity of 
constitution of the patient, and the cause producing 



THIRTY YEARS OF FEMALE LIFE. 265 

it. During the first two or three months, the ovum 
sometimes escapes from the womb with little 
pain, and but slight hemorhage ; at a later period, 
the abortion resembles very much a labor at full 
term ; and in some cases, a woman will suffer as 
much, or more, at two or three months, as at deliv- 
' ery with a full grown child. At an early stage, the 
ovum is sometimes expelled entire, in the form of a 
bag, varying in size according to the period of 
pregnancy ; more frequently, however, the foetus is 
first expelled, and in a few hours, or a day or two, 
the other portions are detached from the womb, 
and pass out in one mass, or in fragments ; or the 
entire ovum, or portions of it, may be retained, un- 
til it is decomposed ; when this is the case, there is 
a more or less disagreeable discharge, which con- 
tinues for a number of days. 

If the pregnancy has advanced to the period of 
quickening, the first indication of a miscarriage 
may be a cessation of the movements of the child, 
the breasts become flaccid, the abdomen relaxes, and 
the woman complains of a cold, heavy weight and 
bearing down sensation in the pelvis, with occasion- 
al chills. 

Before the abortion takes place, there is general- 
ly more or less discharge of a bloody fluid, or it may 
be, of pure blood ; this may continue for a day or 
two, or longer, in some cases, before pains come on, 
and the ovum is expelled ; at other times, the patient 
complains of lassitude, pain in the lower part of the 
back and limbs, headache, pain and soreness in the 



266 THIRTY YEARS OF FEMALE LIFE. 

lower part of the abdomen, nausea, and vomiting, 
fainting, chilk and flashes of heat, a frequent desire 
to pass water, and go to stool ; thirst and other 
symptoms of fever ; coldness of the extremities, a 
sensation of weight in the pelvis, and pain extend- 
ing to the groins and thighs ; after some of these 
symptoms have continued a longer or shorter period, 
labor pains come on, and the foetus is expelled. 
The hemorrhage usually ceases as soon as the ovum 
is expelled ; but when the after-birth is retained, 
or only a small portion of it, or the membranes, 
the hemorrhage may be very profuse, until the 
whole product of conception comes away; after 
which there is a discharge for several days, as after 
delivery at full term, with the secretion of milk in 
the breasts in such quantities as to cause considera- 
ble difficulty sometimes, when the abortion has oc- 
curred at three or three and a half months. 

In some cases, there may be a discharge of blood 
for a number of days, and in rare cases of water, 
yet the woman has been known to complete the 
full term of pregnancy, and be delivered of a 
healthy, full grown child. The after-birth does 
not always come away immediately after the foetus 
is expelled ; it may be retained in the womb for 
months without causing any unfavorable symp- 
toms ; more frequently, however, it is expelled in the 
course of a day or two, during which time, the 
patient is subject to hemorrhage to a greater or 
less extent. In other cases, it is retained three or 
four days or a week, and finally expelled in a pu,- 



THIETY YEARS OF FEMALE LIFE. 267 

trid condition ; or it may remain in the womb until 
it has become entirely decomposed ; in either case, 
it is sometimes attended with a disagreeable dis- 
charge for several days, or the putrid mass remain- 
ing in the womb, may cause puerperal fever of a 
serious character, and in some cas»6, fatal termi- 
nation. 

Inflammation is a frequent result of abortion, 
which may terminate fatally, or result in chronic 
inflammation of the womb or ovaries. "Lastly, 
very alarming hemorrhage may precede or accom- 
pany abortion. I cannot say that I ever met with 
a case in which it proved fatal, though I have seen 
life reduced to the lowest ebb.^'^ 

Treatment. — " In the treatment of a case where 
expulsion is threatened, our object will be either to 
stop that process in time to save the life of the 
foetus, or if this cannot be attained, to carry it 
through in such a manner as to expose the mother 
to as little danger as possible. '^t 

To meet the first indication, the patient should 
observe the recumbent posture, on a hard bed, all 
unnecessary covering removed, and perfect rest 
enjoined, free from all excitements ; the diet 
light and easy of digestion, and hot drinks avoided ; 
the bowels should be moved by saline aperients, 
cold wet cloths applied to the lower part of the 
bowels and external organs ; injections of cold 
water, and a full dose of opium or laudanum admin- 

♦ CtiurcliilPs Midwifery, page 183, f Rigby's Midwifery, page 133. 



268 THIRTY YEARS OF FEMALE LIFE. 

istered, from time to time, until the system comes 
under its influence ; in cases where this drug is not 
borne well by the stomach, a tea-spoonful of lauda- 
num in half a tea-cupful of cold water may be in- 
jected up the rectum. If the patient is in a con- 
dition to bear loss of blood, bleeding from the arm 
will be of service ; also the following mixture, 
spirits of mndierera one ounce, spirits of nitre 
half an ounce, tincture of digitallis two drachms, 
dose, a teaspoonful in a wine glass of water three 
or four hours apart. The tincture of Indian hemp 
is recommended by Dr. Churchill, in five to ten 
drop doses, three times a day. If the female is 
weak and feeble, a more generous diet may be in- 
dulged in, and tonics recommended. A considera- 
ble loss of blood does not always preclude the 
possibility of saving the foetus, as women sometimes 
complete the term of gestation, and are delivered 
of a healthy, full grown child, that have been at- 
tacked during the early period of pregnancy by 
active symptoms of abortion, with a free discharge 
of blood for a number of days. As a general rule, 
however, if there is much hemorrhage, and particu- 
larly if it is attended with uterine contractions 
there is little hope of preventing a premature ex- 
pulsion of the ovum. If, then, there is sufficient 
evidence that the abortion cannot be prevented, 
our next object should be to conduct it to a sucess- 
ful issue, by assisting the uterus to evacuate its 
contents with as little danger or inconvenience to 
the mother as possible. In many cases, little treat- 



THIRTY YEARS OF FEMALE LIFE. 269 

merit is required, if the patient remains quiet ; at 
other times, an abortion of two months only, is at- 
tended with violent pain and hemorrhage, fever, 
and inflammation of a serious character, requiring 
active and energetic treatment. 

When it is necessary to assist the process of abor- 
tion, the ergot of rye is frequently resorted to, and 
sometimes borax is used for the same purpose ; sit- 
ting in hot water, or sitting over the steam from 
hot herbs will often assist in a premature ex- 
pulsion of the ovum, and in some cases, a brisk 
cathartic will have this effect. After the whole 
product of conception has come away, the pa- 
tient should keep quiet for a week or two; even 
after an abortion at the second month, rest, 
in the recumbent posture, is of the utmost import- 
ance. The diet should be light, unstimulating, and 
easy of digestion ; the bowels kept open by gentle 
aperients, and if she complains of much pain and 
soreness of the bowels, apply hot fomentations, 
leeches, a mustard plaster, or a blister ; if fever 
supervene, apply cold to the head, and give more 
active cathartics, opium in some form, Dover pow- 
der and camphor, or calomel, twenty grains, Dover 
powder, thirty grains, camphor, fifteen grains ; 
make six powders, one every four or six hours ; also 
spirits of minderera, and spirits of nitre ; sitting in 
hot water, and soaking the feet in hot water, is often 
of service, particularly if the discharge is less in 
quantity than what it should be. Bleeding from 
the arm may be required in some cases, and leeches 



270 THIRTY YEARS OF FEMALE LIFE. 

to the temples, if there is too much determination 
of blood to the head ; chills are often a troublesome 
symptom ; except a cup of hot penny-royal tea, or 
some other hot drink, they require no special treat- 
ment, as they will cease as soon as the ovum is ex- 
pelled, or before. Serious hemorrhage may occur 
before the ovum is expelled ; this can sometimes be 
restrained by opium, alum, sugar of lead, and other 
astringents ; acid mixture, cold external applications, 
or cold water injections ; if these remedies fail, 
plugging the vagina will check it ; but there will 
be little hope of saving the foetus if the plug is re- 
sorted to ; it should, therefore, be used only in ex- 
treme cases, unless there was evidence that vitality 
of the ovum had been already destroyed. Tor 
plugging the vagina, different articles are used ; Dr. 
Dewees recommends a piece of sponge. Dr. Church- 
ill prefers a silk handkerchief or tow ; cotton wool 
may be used with equal success, or a piece of alum 
as large as can be conveniently introduced ; this 
should be egg shaped, and previously made smooth, 
and have a string attached to it, that it may be the 
more easily removed. If cotton wool is used, or 
other articles of this kind, it should be first wet in 
alum water, or some other astringent liquid, and 
then introduced, portions at a time, until the pas- 
sage is completely filled. After ten or twelve hours 
the plug may be removed, and the mouth of the 
womb examined with the finger ; if the ovum can- 
not be removed, and the hemorhage continue, the 
passage may again be filled as before, and the ergot 



THIRTY YEARS OF FEMALE LIFE. 271 

or borax administered to bring on efficient contrac- 
tions of the womb. Sometimes the plug is expelled, 
along with the ovum, from the force of the uterine 
contractions. 

In case the foetus is expelled, and the after-birth 
remains in the womb, beyond the reach of the fin- 
ger, it may sometimes be removed by instruments 
made for this purpose. Dr. Dewees makes use of a 
wire, bent at one end like a hook, with which the 
after-birth and membranes, can in some cases, be re- 
moved ; rotating the instrument, and twisting the 
membranes into a kind of rope, assists in their re- 
moval. Abortion forceps are also used for the same 
purpose. Some introduce the hand into the vagina, 
and one or two fingers into the womb, and by using 
the end of the finger as a hook, the retained portion 
can sometimes be removed. Although it is of great 
importance that the whole product of conception 
should be removed, yet too much interference 
should be carefully avoided, as greater evils may 
arise than if left to nature and judicious treatment. 
If there is no serious hemorrhage, sitting in hot 
water, or sitting over the steam from hot herbs, also 
hot fomentations to the bowels, will be of service ; 
injecting a stream of warm water, and immediately 
after, a stream of cold water, into the womb, will 
sometimes assist in expelling the retained after-birth. 
If there is serious flooding, a piece of ice may be 
introduced into the vagina ; cold astringent injec- 
tions used, or the plug previously mentioned; opium 
in some form should be given, or some other nar- 



272 THIRTY YEARS OF FEMALE LIFE. 

cotic ; also ergot of rye, sugar of lead, in doses of 
two or three grains, every three or four hours, until 
some effect is produced ; alum, and other astringents, 
together with external cold applications, or cold 
water injections up the rectum. 

In some cases, where there has been a great loss 
of blood before the plug has been resorted to, the 
patient becomes faint, the face pale, lips blanched^ 
the voice scarcely audible, the pulse hardly percep- 
tible, nausea and vomiting supervene, and the ex- 
tremities are cold ; under such circumstances, if a 
reaction is not induced, the patient may sink past 
recovery. Stimulants and anti-spasmodics are now 
indicated, such as hartshorn, valerian, camphor and 
brandy ; warmth should be applied to the feet, and 
a mustard plaster across the stomach, to allay the 
nausea and vomiting ; if she has fainted, apply 
cold water to the face, and hartshorn to the nostrils. 
As a stimulant, bay rum will be found more grateful 
to the stomach, than brandy, or any other liquor, 
besides, it is somewhat astringent. In some cases, 
after the foetus has come away, and clots of blood 
of considerable size have been expelled, the patient, 
mistaking a blood clot for the after-birth, may think 
the abortion completed; being free from hemorrhage 
and feeling able to be about, she gets up and attends 
to her duties ; but in the course of a few days, or 
two or three weeks, it may be, hemorrhage comes 
on, with labor pains, and the after-birth is expelled^ 
in some cases in a perfect condition ; more frequent- 
ly, however, when the after-birth is retained longer 



THIRTY YEARS OF FEMALE LIFE. 273 

than one or two days, decomposition commences, 
after which, it may come away at any moment ; in 
some cases it remains a number of days and pro- 
duces serious and sometimes fatal results. The 
discharge, which is sometimes of very bad odor, 
should be washed away by injecting warm water 
into the womb three or four times a day, or a solu- 
tion of chloride of lime, and hot fomentations ap- 
plied to the bowels. Epsom salts or some other 
saline laxatives, should be administered from time 
to time, to keep the bowels freely open. In some 
cases, the discharge continues two or three weeks, 
or even longer, during which time the general health 
may become seriously affected, requiring bark and 
wine and other tonics. Sometimes the retained 
after-birth is gradually absorbed, without causing 
any constitutional disturbance, and little or no dis- 
charge. It may also assume the form of a mole or 
hydatids, which usually come away in the course 
of a few weeks or months ; or they may remain in 
the womb a number of years ; in other cases, the 
putrid mass causes great constitutional irritation, 
which sometimes terminates fatally. The patient 
complains of pain in the head, the pulse is rapid, 
full and bounding, or weak and thready ; the skin 
hot and dry, great thirst, tongue coated, urine high 
colored, the bowels tender on pressure and some- 
times swollen, the vagina hot and painful to the 
touch, and the womb in the same condition. When 
symptoms of this description declare themselves, 
they give rise to serious apprehensions for the 



274 THIRTY YEARS OF FEMALE LIFE, 

safety of the patient, and require active treatment, 
which is not always able to prevent a fatal termi- 
nation, even in case the after-birth should be ex- 
pelled. Opium, in some form, will be found a val- 
uable remedy, also cypripeden in doses of two 
grains, every three or four hours. Camphor, 
spirits of minderera and spirits of nitre ; Dover 
powder ; gelsemin one fourth or one half a grain 
every two or three hours. The bowels should be 
freely opened, followed by alterative doses of calo- 
mel and Dover powder or opium, or podophyllin 
one fourth of a grain, leptandrin one grain, every 
three or four hours. To assist in expelling the 
after-birth or portions of it which may be retained, 
and check the hemorrhage, ergot or borax will be 
of service, or caulophyllin three grains, three or 
four hours apart, also hot fomentations to the bow- 
els, washing out the womb with warm water, or a 
solution of chloride of lime, as previously mention- 
ed. If there is much soreness of the bowels com- 
plained of on pressure, a dozen leeches or more may 
be applied, or a large blister. When there is a de- 
termination to the head, it should be kept cold by 
cold applications ; leeches to the temples, or a 
blister to the nape of the neck, do good in some 
cases. If the patient will bear loss of blood, bleed- 
ing from the arm will be of service, or stimulants 
and anti-spasmodics may be required ; twelve or 
fifteen drops of diluted sulphuric acid, with epsom 
salts, has been recommended by Dr. Gooch ; 
other saline preparations will sometimes do good, 



THIRTY YEARS OF FEMALE LIFE. 275 

given in small doses every four or six hours, accord- 
ing to effect. In many cases, after an abortion, 
particularly at an early stage of pregnancy, a dis- 
charge of blood continues a number of weeks ; it 
may be constant or only when the woman is about 
on her feet ; increases by going up and down 
stairs, or on the least exertion ; w^hen it is allowed 
to continue for a length of time, the general health 
becomes seriously affected. It is frequently induc- 
ed by not keeping quiet a sufficient length of time 
after the abortion. 

Misplacements and chronic inflammations of the 
womb and ovaries, are often caused in the same 
way. Rest, in the recumbent posture, for a few 
days, should be observed ; cold water, injected up 
the rectum, three or four times a day, will be found 
a valuable remedy ; also thirty or forty drops of 
tincture of ergot, four or six hours apart ; tonics 
will be required in some cases, as quinine, iron, and 
others. 



276 THIRTY YEARS OF FEMALE LIFE, 



CHAPTER XXVI. 

FALSE CONCEPTION. 

This term, as generally understood, implies the 
act of sexual intercourse, and refers to certain sub- 
stances expelled from the womb, attended with 
more or less hemorrhage and pain. If the vitality 
of the ovum is destroyed, in consequence of faulty 
conformation, or disease of the womb, injuries oc- 
curring to the mother, as a fall or blow, certain dis- 
eases, violent emotions of the mind, or any other 
cause, it is generally soon expelled from the womb ; 
not unfrequently, however, it is retained a longer or 
shorter period, and undergoes changes in form and 
structure, which renders it very difficult, in some 
cases, to decide what it really is, at least, without 
a careful examination ; as there are substances ex- 
pelled from the womb, resembling, in some cases, 
very closely, those due to pregnancy, that are not 
entitled to this suspicion. This is particularly the 
case where the ovum is blighted during the first 
three or four weeks after conception, as the foetus 
at this early period, is often dissolved in a day or 
two after vitality ceases, the membranes only re- 
maining, and these are sometimes expelled in frag- 
ments, or infiltrated with blood, presenting the ap- 
pearance of a clot. 



THIRTY YEARS OF FEMLAE LIFE. 277 

Moles. — " By the term mole, authors have intend- 
ed to describe very different productions of, or ex- 
cretions from the uterus. By some it has been used 
to signify every kind of fleshy substance, particular- 
ly those which are properly called polypi ; by others, 
those only which are the consequence of imperfect 
conception, when the ovum is in a morbid or decayed 
state ; and by many, which is the most popular 
opinion, every coagulum of blood, which continues 
long enough in the uterus to assume its form, and to 
retain only the fibrous part, as it is properly called, 
is denominated a mole/^* 

Dr. Burns says : — ^' It is the opinion of many, that 
these substances are never formed in the virgin 
state, and no case that I have yet met with contra- 
dicts the supposition. ^'t 

The true mole, according to the weight of medi- 
cal authority, is the result of sexual intercourse, 
and presupposes conception ; the ovum becoming 
blighted, and retained in the womb, assumes the 
form of a fleshy mass, more or less dense in struc* 
ture, and of variable size, and when expelled, it is 
commonly called a false conception. They may fol- 
low an abortion, or delivery at full term ; some por- 
tion of the after-birth or membrane being retained 
in the womb, forms the nucleus of the mole ; or, as 
previously stated, the ovum being retained in the 
womb after vitality ceases, degenerates into a fleshy 
mass called a mole, which is probably the most com- 

♦Denman-s Midwifery, page 124. f Bum's Midwifery, page 102. 



278 THIRTY YEARS OF FEMALE LIFE. 

mon origin of these abnormal growths. The false 
mole, if the term can be properly applied to sub- 
stances sometimes expelled from the womb in the 
virgin state, may be formed in consequence of some 
abnormal condition of the womb, a polypus tumor, 
or a clot of blood retained in the womb, in cases of 
painful or profuse menstruation ; the contractile 
force of the womb would naturally press out the 
more fluid portion of the clot, leaving a fibrous 
mass, which may be invested with a fleshy covering, 
resembling in its external appearance, the true mole. 
The membrane, also, or a portion of it, which is 
formed in the uterine cavity, in some cases of 
painful menstruation, may be retained, and forms 
the nucleus of a substance, that finally assumes 
the appearance of a morbid growth, like the 
preceding. .It is, therefore, of great importance to 
distinguish between those substances expelled from 
the womb, the consequence of sexual intercourse, 
and those that are not, particularly when the charac- 
ter of the female is in question. As a general rule, 
these morbid growths are expelled at or before the 
full term of pregnancy is completed, frequently 
about the fourth month ; they have been known^ 
however, to remain in the womb several years. Dr. 
Montgomery states that a case is related by Am- 
brose Pare, of a mole being retained in the womb 
seventeen years. The fact that these morbid 
growths are sometimes retained a long time in the 
womb, should be born in mind, as a female might 
be delivered of a mole, after she had been several 



THIRTY YEARS OP FEMALE LIFE. 279 

years a widow, that commenced its growth while 
she was living in wedlock. 

On making an incision into the mole, they are 
sometimes found to be hollow, at other times solid ; 
those that are hollow, contain a watery, bloody fluid, 
and are occasionally as large as the head of a child 
at full term ; generally , however, they are about the 
size of a goose-egg. The solid mole is of larger 
growth than those that are hollow, and as commonly 
met with, they are about the size of a double fist ; 
in either case, they vary considerable in size. 

In some cases of twin conception, there may be 
two moles in the womb, or one ovum only is blighted; 
the woman being delivered at full term, of a healthy, 
full grown child, and at the same time, or a few 
days later, of a false conception or mole. 

Symptoms. — The presence of a mole in the womb 
produces the usual symptoms of true pregnancy ; 
it is, therefore, very difficult to discover the nature 
of the case, at least before the time of quickening, 
unless the mole is expelled before this period, which 
not unfrequently happens ; and in many cases, 
where the mole is retained in the womb after the 
usual time of quickening, the cause of the symptoms 
is mere conjecture, from the fact, that in some women 
who are delivered in due time of a healthy child, 
many of the usual symptoms of pregnancy are ab- 
sent. Yet, as a general rule, there are certain pe- 
culiarities observed in molar pregnancy, that do not 
usually occur in true pregnancy. These are ab- 
sence of the sound produced by the foetal heart, ab- 



280 THIRTY YEARS OF FEMALE LIFE. 

sence of motion of the child, a greater enlargement 
of the abdomen, previous to the period of quickening, 
than in true pregnancy ; and after this period, there 
is a less rapid enlargement of the abdomen, which 
is sometimes painful on pressure ; and not unfre- 
quently, there is a discharge of blood, or watery 
fluid, from the womb, occurring, in some cases, 
about such a time every month, corresponding to 
the regular monthly period ; at other times, it oc- 
curs irregularly as to time. The inconvenience 
arising from the enlargement of the womb, does not 
differ materially from that experienced in true 
pregnancy ; it sometimes feels heavier, and appears 
to roll about from side to side, as the woman 
changes her position ; the breasts, after having been 
more or less distended, frequently shrink, and be- 
come flaccid, and secrete a watery fluid. 

Treatment — The expulsion of the mole is usually 
attended with more or less pain and hemorrhage, 
as in abortion, and requires similar treatment. 

Hydatids. — These morbid growths, sometimes 
called false conception, are a species of mole, and 
consist of numerous vesicles, or little sacks, filled 
with a watery fluid ; they vary in size from a pin's 
head to that of a large grape. In some cases, they 
exist in large numbers, connected together like 
bunches of grapes. At other times, there is only 
a few of them, and these may be attached to an 
after-birth, or a portion of it, or some portion of 
the membranes of an ovum. In regard to the 
origin of hydatids, as in the case of moles, a diver- 



THIRTY YEARS OF FEMALE LIFE. 281 

sity of opinion exists amongst authors, some con- 
tending that they may be formed independent of 
sexual intercourse ; whilst others, high in authority, 
regard them as resulting from impregnation. Dr. 
Montgomery says, '^ my own belief, then, is that 
uterine hydatids do not occur except after sexual 
intercourse, and as a consequence of impregnation ; 
never having met, or heard of a case, in which 
their presence was not accompanied, or preceded 
by the usual symptoms of pregnancy. In every 
instance under my immediate observation, the 
women supposed themselves with child, and when 
the contents of the uterus was expelled, there was 
found either a blighted foetus or some other part 
of the ovum." " Still it must be confessed, that 
our knowledge on this point is by no means suffi- 
ciently precise, nor our collection of facts sufficient- 
ly extended to warrant us in pronouncing positive- 
ly on the question, or asserting decidedly, in a case 
of suspicion, that a woman was pregnant, merely 
because she discharged hydatids from the uterus, 
except we could detect, along with them, some 
constituent part of the ovum, or in an examination 
after death, find in the ovary the true corpus lute- 
um, which ought to put an end to all doubt."^ 

Dr. Meigs says *' I have never heard of hydatids 
in the virgin, nor do I believe that a virgin could 
have a hydatid, or any thing like it, developed in 
her womb. I have met with them only in married 

* Montgomery on Pregnancy, page 220. 



282 THIRTY YEARS OF FEMALE LIFE. 

women. I do not regard them as hydatids, or aceph- 
alocysts ; but I think they are morbid products of 
conception. '^^ 

The opinion of several other eminent authors, as 
expressed in their writings, favors this view ; that 
there is the strongest evidence, short of positive 
proof, that hydatids are the consequence of concep- 
tion. These morbid growths, have been known to 
be retained in the womb several years ; generally, 
however, they are expelled at or before the full 
term of pregnancy is completed, frequently about 
the sixth or seventh month. 

Symptoms. — The remarks in regard to the symp- 
toms and peculiarities observed in the case of moles, 
apply in the case of hydatids ; there is also more 
frequently a discharge of blood or watery fluid 
from the womb, and in some cases, there is a dis- 
charge of portions of hydatids from time to time, 
previous to the final expulsion of the whole mass : 
this, of course, reveals the true nature of the case ; 
but, aside from this occasional occurrence, it is often 
very difficult to tell whether the womb contains a 
mole or hydatids. Sooner or later, pains like labor 
come on, and the mass is expelled, as in a case of 
abortion, or premature delivery, and requires similar 
treatment and management. 

* Meigs on Diseases of Women, page 349. 



THIRTY YEARS OP FEMALE LIFE. 283 



CHAPTER XXVn. 



STERILITY. 



According to the common acceptation of the 
term, sterility means an unfitness, or inaptitude on 
the part of the female, to become impregnated. 
This may result from various causes, such as closure 
of the fallopian tubes ; absence, malformation and 
imperfect development of the organs concerned in 
the reproductive process ; organic disease of the 
womb or ovaries ; and tumors of these organs ; chron- 
ic inflammation, and congestion of the womb or 
ovaries ; ulceration of the womb or contraction of 
the passage through the neck of the organ ; mis- 
placements of the womb, leucorrhoea, and immoder- 
ate sexual indulgence. 

Closure of the fallopian tubes, absence, malform- 
ation, and imperfect development of the generative 
organs, are as rarely met with, as the subjects of 
sterility are numerous ; we must, therefore, look to 
causes of more frequent occurrence, for an explan- 
ation of the unfruitfulness. In most cases, these 
will be found to be, chronic inflammation of the 
ovaries or womb ; an irritable condition of the 
womb ; ulceration, or contraction of the passage 
through the neck of the womb ; excessive sexual 



284 THIRTY YEARS OF FEMALE LIFE. 

indulgence, and leucorrhoea. Tumors, organic dis- 
ease, and misplacements of the womb, are no doubt 
causes of sterility, in some cases ; but these morbid 
growths, and abnormal conditions, are usually associ- 
ated with more or less inflammation and congestion 
of the organ, which is probably sufficient of itself 
to cause barrenness. An irritable condition of the 
womb may cause sterility, and excessive sexual in- 
dulgence may induce chronic inflammation of the 
womb or ovaries, and irritable uterus ; when this 
is the case, more moderation should be practiced, 
and the time selected for sexual intercourse, which 
should be just before or after a monthly period ; 
also, proper treatment, to restore the internal 
organs to a healthy condition, should be be resorted 
to. 

Sterility is not unfrequently associated with 
painful, profuse, or obstructed menstruation, ulcer- 
ation of the womb, and leucorrhoea ; in either case, 
be the cause of barrenness what it may, to cure 
the infirmity,* the cause must be removed. In some 
cases, this is beyond the reach of remedies, as 
where it depends upon some incurable disease, 
malformation, absence, or imperfect development of 
the generative organs ] or where the non-productive- 
ness of the female depends upon some condition of 
the male ; in the latter cases, if amenable to treat- 
ment, they do not come within the scope of this 
treatise. 

It has been proved by investigations of modern 
origin, that when in a healthy condition, the mu- 



THIRTY YEARS OF FEMLAE LIFE. 285 

cous membrane lining the cavity of the womb, 
secretes an alkaline fluid, and the mucous membrane 
of the vagina an acid fluid ; the alkaline secretion 
from the womb tends to neutralize that of the va- 
gina ; one object of this uterine and vaginal secre- 
tion, is to moisten or lubricate the mucous surfaces 
and prevent adhesion. This lubricating fluid may 
be reduced in quantity, in consequence of diseased 
action, causing a dryness of the parts, with more 
or less inconvenience, or the quantity may be 
greatly increased, recognized by the term leucorr- 
h'oea ; the result, in either case, of acute or chron- 
ic inflammation, in most cases. A similar result is 
observed in inflammatory affections of the throat 
and breathing tubes ; at first, there is a dryness or 
hoarseness, which continues a longer or shorter 
period, followed by a more or less copious expec- 
toration of mucous. The natural secretion of the 
mucous membrane of the vagina, and cavity of the 
womb, is not only increased in quantity in leucorr- 
hoea, but it is frequently altered in quality also ; 
that from the womb, instead of being alkaline, may, 
in consequence of abnormal action, become deci- 
dedly acid, which, added to the vaginal secretion, 
increases its acid properties to such a degree, as to 
destroy the vitality of the male semen, thereby 
causing sterility. The same result may occur, if 
from certain conditions of the womb, the alkaline 
secretion from that organ is suspended, in which 
case, the vaginal secretion becomes more decided- 
ly acid, in consequence *of the absence of the 



286 THIRTY YEARS OF FEMALE LIFE. 

neutralizing influence of the alkaline secretion from 
the womb. 



CHAPTER XXVin. 

CONYULSIONS. 

The intimate connection between the womb and 
nervous system generally, and the frequent exam- 
ples of reflex action, render the female extremely 
obnoxious to convulsions, both before, during and 
after child-birth. They also occur independent of 
pregnancy. By some authors, convulsions are divi- 
ded into hysteric, epileptic, and apoplectic convul- 
sions ; other divisions are sometimes made, but 
they are probably modifications of the above. The 
hysteric form has been previously considered, and 
as the symptoms or treatment does not diff'er in any 
essential particulars, whether the attacks are asso- 
ciated with pregnancy or not, we shall pass without 
further remarks on this complaint, to the considera- 
tion of the epileptic variety. 

Epileptic convulsions occurring just before, 
during, or soon after delivery, constitutes that pe- 
culiar malady, usually recognized as puerperal con- 
vulsions. That the affection is intimately con- 
nected with uterine action, is pretty clearly made 
out by the fact, that, if the convulsions come on two 
or three months before full term, contractions of the 



THIRTY YEARS OF FEMALE LIFE. 287 

womb generally take place, followed, in some cases, 
immediately, by premature labor. The complaint 
usually occurs during delivery, or soon after, and at- 
tacks women in their first pregnancy more frequent- 
ly than at any other time. In regard to the cause 
of puerperal convulsions. Dr. Locock remarks : — 
*^The immediate causes of puerperal convulsions 
are often very obscure. They appear, sometimes, to 
depend upon a loaded state of the brain ; at other 
times, the brain appears to be influenced by distant 
irritation, either in the uterus or digestive organs ; 
and again, in some cases, puerperal convulsions are 
induced, apparently, by a peculiar irritability of the 
nervous system. It has been remarked that there 
has been a greater disposition to puerperal convul- 
sions in those patients, who have been, in early 
life, subject to convulsive attacks, particularly of an 
epileptic character ; and also, in those, who have 
suffered similarly in former labors, and have omit- 
ted those measures usually employed as precautions. 
That the uterine organs are in some way particular- 
ly implicated, is evident from the convulsions being 
of a character which may be said to be peculiar to 
the state of either pregnancy or parturition." 

" The immediate attack may be brought on by a 
loaded or disordered stomach, or by food, however 
small in quantity, of an indigestible kind. Some 
substances, (shell-fish for instance) have been found 
very frequently to induce convulsions in the puer- 
peral condition, when, at other times, they may 
have been taken by the same individual with per- 



288 THIRTY YEARS OF FEMALE LIFE. 

feet impunity. A sudden fright, aflBicting intelli- 
gence, or any unexpected or depressing mental 
emotions, may excite the paroxysm ; hence it has 
been long remarked, that unmarried women are 
more particularly likely to be sufferers from convul- 
sions, from the shame and distress under which 
their children are usually born. The violent strain- 
ing caused by labor pains, from the disturbance of 
the frame by the earlier uterine contractions, caus- 
ing a temporary rush of blood to the head, will 
sometimes bring on convulsions.'^^ 

A plurality of children has been regarded as a 
predisposing cause ; also certain atmospheric con- 
ditions ; a number of cases appearing in a section 
of country at the same time, like an epidemic. 
"And here I may be allowed to observe, that I 
have witnessed the occurrence of several cases 
during warm weather, at a time when the clouds 
have been charged w^ith electric fluid ; when at- 
mospheric appearances have threatened a thunder 
. storm, and when, perhaps, they have ended in one.''t 

The theory advanced by Dr. Marshall Hall, in 
regard to the immediate cause of puerperal con- 
vulsions, is of no little importance. He considers 
that in all cases of this complaint, there is an ab- 
normal condition of the great nervous centre, the 
spinal marrow, and particularly the upper portion 
of the medulla oblongata. In this opinion he is 



♦ Cyclopedia of Practical Medicine Art. Puerperal Convulsions. 
f Ramsbotham Pract. observations in Midwifery, page 250, vol. I. 



THIRTY YEARS OF FEMALE LIFE. 289 

ably sustained by several authors, and amongst 
them Dr. Tyler Smith, who remarks as follows ; '' In 
conclusion, to give a summary of the whole subject, 
the true puerperal convulsion can only occur when 
the central organ of this system, the spinal mar- 
row, has been acted on by an excited condition of 
an important class of its incident nerves, namely ; 
those passing from the uterine organs to the spinal 
centre ; such excitement depending on pregnancy, 
labor, or the puerperal state. Notwithstanding 
puerperal convulsions are often attended with most 
distressing symptoms, and often fatal results, the 
appearances after death very seldom disclose le- 
sion of structure sufficient to explain the peculiar- 
ities of the malady. Judging from the severity 
of the sjTuptoms, and appearances of the patient 
when laboring under an attack of this complaint, 
we would naturally expect to find, on examination 
after death, considerable congestion of the brain, 
infiltration into its substance, ventricles, or between 
the membranes, but this is rarely the case. It is 
true these appearances are occasionally met with, 
but they form the exception to the rule. Dr. 
Ramsbotham remarks that " the whole train of symp- 
toms evinces considerable derangement in the func- 
tions of the brain and nervous system ; yet, after 
death, corespondent marks of organic mischief with- 
in the head are seldom met with. The different 
anatomical inquiries at which I have been present, 
have not disclosed such regular appearances as to 
sanction the uniform deduction that the brain was 



290 THIRTY YEARS OF FEMALE LIFE. 

the principal seat of the disease. T suspect, in 
many instances, that important organ is no other- 
wise implicated than through the medium of sym- 
pathetic irritation.'''^ 

Dr. Merriman observes in relation to this subject : 
" Of the appearances after death, in those who have 
died of puerperal epilepsia, contrary statements 
have been given. Dr Denman says, that in the 
examination of many women who have died from 
convulsions, he has never seen an instance of effu- 
sion of blood in the brain, though the vessels were 
extremely turgid ; but has always remarked, that 
the heart was unusually flaccid, without a single 
drop in the auricles or ventricles ; but he adds that 
Mr. Hewson had informed him of a case of convul- 
sions, where an effusion of blood in a small quantity, 
had been found on the surface of the brain ; and 
in his fifth edition, he mentions a case by Dr. Hoop- 
er, where a coagalum of blood, weighing nearly 
four ounces, was found between the dura and pia 
mater. In one instance, I have distinctly seen an 
effusion of blood in the posterior part of the cra- 
nium ; but the quantity was not large, and Dr. Ley 
has lately met with a similar case.'' M. Cruvilhier 
and M. Bontilleux, in their examinations could detect 
no manifest alteration within the skull, and Dr. 
Collins says : " I conceive we are quite ignorant, as 
yet, of what the cause may be ; nor could I ever 
find, on dissection, any appearance to enable me 
to even hazard an opinion on the subject."! 

♦ Ramsbotham, vol ii, page 248. fL^^'s Midwifery, page 399. 



THIRTY YEARS OP FEMALE LIFE. 291 

Womeil of a full and plethoric habit are said to 
be more subject to convulsions than those of an 
opposite condition. Over-distension of the blood 
vessels of the upper portion of the body, plays an 
important part in this complaint. This condition 
is caused by the enlarged womb pressing upon the 
large vessels within the abdomen, preventing a free 
circulation. The blood thus impeded in its course, 
is determined to the head and upper portion of the 
body ; the vessels are thus more or less congested. 
This condition is greatly increased during a parox- 
ysm, from the violent contractions of the abdomi- 
nal muscles forcing the womb more firmly against 
the blood vessels, obstructing the circulation to a 
greater degree than at any other time. The im- 
pregnated womb not only obstructs the circulation 
from its increased size, but it also interferes \vith 
the functions of the kidneys, in many cases, from 
the same cause ; and this result is greatly aided by 
the over-loaded condition of the bowels, which 
often exists in the latter months of pregnancy. 

The natural function of the kidneys is to separate 
noxious qualities from the blood, but when inter- 
fered with, the natural function is changed to abnor- 
mal action, and instead of the natural quantity of 
healthy urine, it is frequently reduced in quantity, 
and altered in quality. Urea, that should be elimi- 
nated from the system, through the urinary organs, 
is retained in the circulation, exerting a deleterious 
influence on the blood ; and at the same time, al- 
bumen is observed in the urine. In reference to 



292 THIRTY YEARS OF FEMALE LIFl!. 

this subject, Dr. Lever remarks : — '' I have carefully 
examined the urine in every case of puerperal con- 
vulsions that has since come under my notice, and 
in every case, but one, the urine has been found al- 
buminous at the time of the convulsions. I have 
further investigated the condition of the urine in 
upwards of fifty women, from whom the secretion 
has been draw^n, during labor, by the catheter ; 
great care being taken that none of the vaginal dis- 
charges were mixed with the fluid ; and the result 
has been that in no case have I detected albumen, 
except in those in which there have been convul- 
sions, or in which symptoms have presented them- 
selves which are readily recognized as precursors 
of puerperal fits.'*"^ 

Further investigations in this direction may re- 
sult in explaining the phenomena of this mysterious 
malady ; for it is frequently observed in hysteric 
convulsions, that the patient passes a quantity of 
urine, altered in quality, immediately after the at- 
tack, w^hich shows that the convulsions exert an in- 
fluence on this secretion, or that it is affected, in 
some way, by the paroxysms. 

Symptoms. — Epileptic convulsions do not differ 
materially from an ordinary epileptic paroxysm. 
In some cases, the attack is preceded by premonito- 
ry symptoms, as pain in the head, diflSculty of hear- 
ing or seeing, ringing in the ears, and dizziness ; 
the face is flushed, the eyes roll in their socketSithe 

* Churcbill on Diseases of Women, page 496. 



THIRTY YEARS OF FEMLAE LIFE. 293 

muscles of the face twitch convulsively, and in 
some cases vomiting occurs. These symptoms in- 
crease in severity, the blood rushes to the head, the 
face assumes a livid hue, the pupils of the eyes be- 
come dilated and insensible to light, and turned up- 
wards or inwards. In some cases, the lids are closed, 
the jaws firmly set, or the lower jaw is drawn to one 
side, the nostrils dilated, foam issues from the mouth, 
the breathing is laborious, and performed with a hiss- 
ing noise, or nearly suspended. From the impeded 
respiration, the whole surface of the body becomes 
of a purplish hue ; the patient is insensible to sur- 
rounding objects ; she throws herself wildly about ; 
the abdominal muscles are firmly contracted, and 
the whole muscular system violently convulsed. 
The face is frequently greatly contorted, and the 
head jerked to one side, or turned back ; the tongue 
is often lacerated by being thrust between the teeth 
when the jaws are brought together by the contrac- 
tions of the muscles. As the attack passes off, the 
struggles become less violent, and gradually cease ; 
the breathing becomes more regular, the counte- 
nance more natural, and the patient rests quietly in 
a deep stupor. The paroxysm is usually of short 
duration, sometimes occupying only five or ten 
minutes, in others, twenty or thirty ; the patient re- 
turning to consciousness, in some cases, before an- 
other fit comes on ; and if proper measures are 
taken, another fit can sometimes be prevented. One 
attack succeeds another in quick succession, in some 
cases ; in others, several hours may elapse between 



294 THIRTY YEARS OF FEMALE LIFE. 

them; the number of the paroxysms being governed, 
to a great extent, by the treatment. The paroxysm 
frequently comes on, suddenly, without any premoni- 
tory symptoms ; or the patient may utter a piercing 
shriek, or refer to a violent pain in her head, and 
immediately be seized with violent convulsions. If 
the attack comes on after labor has commenced, the 
delivery is not usually prolonged in consequence. 
In some cases, the birth of the child is accomplished 
while the woman is unconscious ; and not unfre- 
quently, the child is still-born, with appearances, in 
many cases, of having been dead some time. Puer- 
peral convulsions, occurring early in pregnancy, 
often result in death to the foetus ; the danger to 
the child being less, when the labor has progressed 
so far that delivery can be speedily accomplished ; 
but the danger to the mother is greater at full term, 
than when the convulsions occur at an earlier peri- 
od of pregnancy. In many cases, peritoneal in- 
flammation sets in, after the delivery is over, and the 
convulsions have ceased, which greatly increases 
the danger to the mother. 

Treatment. — The importance of general bleeding 
in this complaint, is generally conceded, and bleed- 
ing freely too, with a full stream, not so much 
with the view of curing the convulsions, as to 
counteract the determination to the head, and 
relieve the brain ; but the effect of the bleed- 
ing must be closely watched, and the amount gov- 
erned by the condition of the patient, the effect 
produced, and the quantity previously lost, particu- 



THIRTY YEARS OF FEMALE LIFE. 295 

larly in cases of convultions occurring after delivery. 
When bleeding from the arm has been carried as 
far as the appearance of the patient seems to admit, 
and the effect on the determination to the head has 
not been sufficient, or in cases where, from previous 
loss of blood, general bleeding is not admissible, 
leeches to the temples may be applied with benefit, 
also cupping the back of the neck, or both. The 
head should be shaved, and cold applications put 
on, or a blister may be applied to the nape of the 
neck and head. The feet and legs should be 
immersed in hot water, or hot poultices applied 
to them, as mustard and others. Free evacuation 
of the bowels by active cathartics, as calomel 
and jalap, is of importance ; or the bowels may 
be previously moved by injections ; after this has 
been accomplished, a tea-spoonful of laudanum 
.in half a tea-cupful of warm water or thin starch, 
may be injected up the rectum ; or a full dose of 
laudanum, thirty or forty drops, or one grain of 
opium, administered by the mouth, and repeated as 
occasion requires. Tartar emetic has been favor- 
ably mentioned by Dr. Collins, given in small doses, 
sufficient to produce nausea only ; tincture of digit- 
alis, ten or fifteen drops, in a tea-spoonful of ammo- 
niated tincture of valerian, and other anti-spasmod- 
ics, will be of service between the paroxysms. As 
the convulsions frequently cease immediately after 
delivery, the induction of premature labor has been 
proposed, in cases where the attack comes on before 
the full term is completed, the fits being rebellious 



296 THIRTY YEARS OF FEMALE LIFE. 

to treatment, severe, and of frequent occurrence ; 
and Avhen the attack occurs at full term, to use all 
reasonable means to expedite delivery. 

Apopletic Convulsions. — The principal differ- 
ence between this form of the complaint and the 
preceding variety, consists in a greater determina- 
tion to the head, congestion of the brain, effusion of 
blood or serum into its substance, ventricles, be- 
tween the membranes, or at the base of the brain. 
It is more apt to occur, during the latter part of 
labor, or soon after it has terminated, than at any 
other time. There is little or no frothing at the 
mouth, less convulsive movements, and proves more 
frequently and suddenly fatal than the epileptic 
form. The symptoms demand prompt and free 
bleeding, either general or local, or both, and other 
remedies as in the preceding variety. When re- 
covery does occur after an attack of apopletic or 
epileptic convulsions, the mind is sometimes affect- 
ed for a considerable time afterwards, if not per- 
manently. 



THIRTY YEARS OF FEMALE LIFE. 297 



CHAPTER XXIX. 

PUERPERAL, OR CHILD-BED FEVER. 

Soon after delivery, women are sometimes at- 
tacked with puerperal peritonitis, or puerperal 
fever, commonly called child-bed fever ; attended 
with great suffering, and often fatal in its termi- 
nation. 

It has several times prevailed as an epidemic, 
both in hospital and private practice, causing 
fearful havoc amongst lying-in women, in all condi- 
ditions of life. Puerperal fever depends upon in- 
flammation of the womb, or its appendages, or the 
peritoneum. 

The membrane lining the cavity of the abdomen, 
is called peritoneum ; it envelopes the intestines, 
womb, ovaries, fallopian tubes, ligaments of the 
the womb and bladder, all of which, may be more 
or less affected in this complaint ; more frequently, 
however, the peritoneum or womb, or both, is the 
principal seat of the disease. It may commence in 
the womb, and spread to other organs and tissues, 
or the ovaries may be first attacked, other portions 
of the pelvic viscera, sooner or later, becoming im- 
plicated in the malady. 

In regard to the contagious, or non-contagious 



298 THIRTY TEARS OP FEMALE LIFE. 

character of puerperal fever, there is considerable 
diversity of opinion amongst medical writers ; some 
high in authority, contending that it is contagious 
others, again, equally eminent, are strenuously op 
posed to this doctrine. If not, strictly speaking 
an infectious disease, it has not unfrequently mani 
fested itself under circumstances similar to those 
observed in contagious diseases. In view of the 
possibility of transmitting it from one patient to 
another, every precaution should be used, to pre- 
vent such an occurrence, by those having the care 
of puerperal women. Child-bed fever generally 
commences by the third or fourth day after deliv- 
ery ; it has occurred, in some cases, much later than 
this, and sometimes it occurs within a few hours 
after the birth of the child ; instances are also re- 
corded, where it commenced before delivery. Puer- 
peral peritonitis not unfrequently occurs after 
abortion, even at an early stage of the conception ; 
in fact, a woman is more liable to inflammation of 
the peritoneum, womb, or its appendages, from 
abortion, than from delivery at full term ; although 
in the former case, the malady is generally of a 
less serious character, and more easily managed, 
than in the latter. 

Causes. — Although the cause or causes of this 
serious malady are obscure, and perhaps unknown 
in many instances, we may mention difficult labor, 
the use of instruments to expedite delivery, a clot 
of blood, portions of the membranes, or after-birth 
retained in the womb, a bad state of health pre- 



THIRTY YEARS OF FEMALE LIFE. 299 

vious to lying-in, costiveness, epidemic influences, 
contagion, the use of stimulants, the ejQTect of cold, 
getting up too soon after delivery, chronic inflam* 
mation of the womb previously existing, which is 
rendered acute as a consequence of delivery. This 
is no doubt a cause of child-bed fever, more fre- 
quently than is generally supposed, and will be 
more easily understood by referring to what has 
been previously stated, that the womb may be af- 
fected with chronic inflammation for years, liable 
to assume the acute form at any time, from certain 
causes. The violent and powerful contractions of 
the womb during delivery, may most certainly be 
sufficient to convert a chronic inflammation of the 
womb into acute inflammation, w^hich may be con- 
fined to that organ, or spread to other portions of 
the pelvic viscera, and develope this fearful 
malady. 

When the disease occurs after abortion, it may 
be caused by medicines, or instruments used for 
the purpose of producing the abortion ; by the vio- 
lent action of the womb to expel the product of 
conception, or portions of it being retained too long 
in the womb, and getting up too soon after the abor- 
tion; also chronic inflammation, rendered acute, as a 
consequence of abortion. 

Symptoms. — As a general thing, child-bed fever 
comes on suddenly ; the attack may be preceded by 
a slight chill, or a severe ague, or the the patient 
may first complain of pain in some portion of the 
abdomen, frequently in the lower part, near the 



300 THIRTY YEARS OF FEMALE LIFE. 

groin, which soon extends upwards until the whole 
or greater portion of the abdomen becomes exquis- 
itely tender; the slightest touch, or the weight of the 
bed-clothes aggravates the pain ; sooner or later, the 
bowels begin to swell, which may increase until 
they become as large as they were previous to de- 
livery. There is generally intense headache and 
thirst ; the skin is hot and dry, or during the lat- 
ter stages, when about to terminate fatally, cover- 
ed with a clammy perspiration ; the pulse is very 
quick, often one hundred and thirty or one hundred 
and sixty beats per minute, full and vibrating, or 
weak, tremulous, and intermitting ; the respiration 
is hurried and laborious ; the tongue white and 
moist, and sometimes red around the edges, and 
covered with a dark fur in the centre ; the urine is 
high colored, diminished in quantity, deposits a sed- 
iment on standing, and is frequently passed with 
considerable smarting pain. In some cases, there 
is diarrhoea, in others the bowels are constipated ; 
the lochia, or discharge from the womb, is generally 
suppressed, and when the disease comes on after 
the secretion of milk has taken place, this is usual- 
ly checked also. The bowels are so very tender 
and painful, that the patient cannot bear to be mov- 
ed ; she prefers to lie on her back, with the head 
well raised by pillows, with the knees drawn up, 
which position seems to give a little relief; there 
is frequently nausea and vomiting, which at first is 
merely a thin, watery fluid ; as it continues, the 
matters vomited assume a billions character, and 



THIRTr YEARS OF FEMALE LIFE. 301 

in the severer forms of the malady, it turns to regu- 
lar black vomit ; hiccough is a frequent symptom, 
and adds greatly to her distress. 

To say that a woman suffers greatly during an at- 
tack of child-bed fever, is a meaningless expression, 
the agony is intense ; far beyond the power of 
words to express. 

In regard to the appearances disclosed by an ex- 
amination after death, Dr. Gooch remarks : — ^' On 
opening the abdomen, which was often as large as 
before delivery, the intestines were found distended 
with air, the peritoneum was red in various parts, 
its surface was covered with a coat of lymph, the 
intestines adhered to one another, and the omentum 
to the intestines ; coagulable lymph was deposited 
on various surfaces, especially in the depressions be- 
tween the convolutions of the bowels, and on the 
omentum, on both of which parts it often lay in 
large masses ; the cavity of the peritoneum con- 
tained several pints of a turbid fluid, apparently 
serum mixed with lymph. In the uterus, the mor- 
bid appearances were generally confined to its peri- 
toneal covering, which was coated with lymph ; on 
removing which, the membrane itself was found un- 
naturally red ; but in some cases, the disease had 
penetrated deeper into the uterus, the substance of 
which was sometimes infiltrated with pus, and some- 
times contained small abscesses, about the size of a 
nut ; the inner surface of the uterus, especially at 
the fundus, often appeared black and ragged, as if 
gangrenous. The enlargement of the abdomen de- 



302 THIRTY YEARS OF FEMALE LIFE. 

pended entirely on air in the intestines ; when 
there was no air there was no enlargement, even 
though the peritoneum contained several pints of 
fluid;^^ 

Treatment. — Child-bed fever runs a rapid course, 
frequently terminating fatally by the fifth day after 
the attack ; it therefore demands prompt and ener- 
getic treatment, which will be modified some- 
what, by the severity of the symptoms, the length 
of time elapsed since the disease first manifested it- 
self, and whether epidemic or not. 

The most fatal cases of puerperal fever, and at the 
same time, most intractable, are when the disease 
prevails as an epidemic ; at such times, also, a mode 
of treatment may be very successful in one epidem- 
ic, and most signally fail in another ; this has led to 
lengthy discussions, and great diversity of opinion, 
in regard to the proper course of treatment in this 
complaint ; some contending, that a free and copious 
bleeding produced the most favorable results, and 
without it, nearly every case terminated fatally ; 
others again, asserting, that when this course of 
treatment was adopted, the patients almost invaria- 
bly died. This diversity of opinion has resulted 
from viewing one epidemic, as a type of puerperal 
fever in general, which is far from being the case : 
also, whether the disease occurred in hospital or 
private practice, in the city or in the country, and 
the length of time elapsed between the commence- 
ment of the attack, and the time that bleeding was 
resorted to, and the quantity of blood taken. 

*Gooch on Diseases of Women, pa^es 49 and 60. 



THIRTY YEARS OF FEMALE LIFE. 303 

The pain in some portion of the abdomen, fre- 
quentlj^ the first symptom complained of, is often 
considered nothing more than an after-pain, for 
which a grain of opium, a dose of morphine, laudan- 
ima, or camphor, or a tea-spoonful of laudanum in 
half a tea-cupful of thin starch, injected up the rec- 
tum, repeated occasionally, Avill generally bring re- 
lief ; it is, therefore, not unfrequently past cure, be- 
fore the true nature of the malady is understood ; 
for it has been proved by sad experience, that if pu- 
erperal fever is cured at all, particularly in its se- 
verer forms, it must be treated promptly, and at the 
very outset ; a few hours delay being sufiicient, in 
many cases, to render all attempts to bring about a 
favorable issue utterly futile. Notwithstanding the 
opposition previously referred to, in regard to gen- 
eral bleeding in puerperal fever, the weight of au- 
thority, at the present day, is decidedly in favor of 
it. Bleeding, then, is the first and most important 
remedy in the treatment of this complaint, but it 
must be resorted to at the very outset of the disease. 
In connection with this subject, Dr. Gordon says :— 
" If called to a case within twelve hours after the 
attack, I insisted on bleeding the patient, and prom- 
ised for its success ; but, if at a later period, viz. 
from twelve to twenty -four hours after the attack. 
I thought it incumbent on me to propose it as the 
only efi'ectual remedy ; but I neither insisted upon 
it, nor promised for its success."* 

In regard to the quantity of blood to be taken, 

* Gordon's treatise on Puerperal fever, page 60. 



304 THIRTY YEARS OF FEMALE LIFE. 

the same author remarks : — '' When I took away 
only ten or twelve ounces of blood from my patient, 
she always died ; but when I had the courage to 
take away twenty or twenty-four ounces at one 
bleeding, in the beginning of the disease, she never 
failed to recover.'^ Although many years have 
passed since Gordon^s time, his treatment in puer- 
peral fever has gained in popularity, and is to-day 
resorted to, in successfully combatting this fearful 
malady. 

The ob^'ect in bleeding is to reduce the inflamma- 
tion, prevent effusion into the peritoneal cavity, 
and check the disorganizing process, its almost in- 
variable result. A favorable effect will be ascer- 
tained, by the relief manifested by the patient, a 
more natural pulse, and less pain and tenderness of 
the abdomen. In some cases, before this is at- 
tained, it may be necessary to repeat the bleeding, 
and also to take, at the first bleeding, a larger quan- 
tity even than that recommended by Dr. Gordon. 
After bleeding, or in cases where it has not been 
advisable to resort to it, if the abdomen is very 
tender and painful, apply leeches, a dozen or more 
at a time ; also hot fomentations, such as cloths 
wrung out of hot water, or hot spirits; or a poultice 
made by steeping some kind of herb, as catnip or 
boneset, and thickening the tea thus made with 
Indian meal. If the weight of the poultice thus 
made causes pain, apply a bag of scalded bran, it 
will be much lighter, and it will also retain the heat 
and moisture a long time. If there is much pain in 



THIRTY YEARS OF FEMALE LIFE. 305 

the head, apply leeches to the temples, or a blister 
to the nape of the neck, and cold applications to 
the head. An important part of the treatment 
consists in freely evacuating the bowels ; for this 
purpose, ten or fifteen grains of calomel, with the 
same quantity of jalap, and five grains of ipecac, 
may be given at a dose, followed by a dose of cas- 
tor oil, or epsom salts, and the bowels afterwards 
kept freely open by saline apereints ; if there is 
nausea and vomiting, apply a mustard plaster over 
the stomach ; administer the calomel, and omit the 
jalap and ipecac ; in some cases injections are of 
service ; this course also has a tendency to relieve the 
bloated condition of the bowels. The spirits of 
turpentine has been given with good success in 
many cases, in doses of fifteen or twenty drops, 
mixed with mucilage, or yolk of egg, and repeated 
every two or four hours. It has also been adminis- 
tered as an injection, half an ounce or an ounce at 
a time, suspended in mucilage, or yolk of eggs, in 
half a teacup-ful of warm water ; it is also applied 
externally to the bowels, with advantage. Opium, 
or some of its preparations, is a valuable remedy in 
this complaint, as a grain of opium, a fourth or 
sixth of a grain of morphia, thirty or forty drops 
of laudanum, or eight or ten grains of Dover's 
powder, repeated in two, four, or six hours, according 
to the effect produced ; also hyoscyamus fifteen 
grains, camphor twenty grains, divided into five 
portions, one, three or four hours apart ; or six 
grains of Dover's powder and three grains of cam- 



306 THIRTY TEARS OF FEMALE LIFE. 

phor, every three or four hours ; or the Dover's pow- 
ders may be combined with two or three grains of 
calomel, with advantage, and repeated every three 
or six hours. Calomel has long held a favorable 
position in the treatment of this complaint, admin- 
istered in small doses, and repeated every four or 
six hours, until a decided amendment takes place, 
or the gums become tender. If it acts on the bow- 
els, producing too frequent evacuations, it must be 
restrained in its action, by Dover^s powders, opium, 
or some astringent preparation. Tartar emetic also, 
produces favorable results in many cases, given in 
doses of an eight, or fourth of a grain, every two, 
four or six hours ; but if it should run off at the 
bowels, restrain it, as in the case of calomel, and 
should it induce vomiting, give it in smaller doses, 
and not so often, and discontinue it entirely, if the 
vomiting cannot be controled. 

From the high commendations in favor of Gelse- 
min, in serous inflammations, it is entitled to a fair 
trial in this complaint ; but if there is great pros- 
tration of the vital forces, as occurs when this 
disease assumes the typhoid form, it is contra-indi- 
cated ; dose, one eighth, or one fourth of a grain, 
two, or four hours apart. Spirits of mindererus two 
ounces, tincture of digitalis half a drachm ; dose, a 
table-spoonful, every four or six hours, will be of 
service in some cases. If the patient continues to 
vomit after applying the mustard plaster, apply a 
blister to the stomach, or give ten or fifteen grains 
of calomel ; should this be ejected, give another dose; 



THIRTY YEARS OF FEMALE LIFE. 307 

the second or third will frequently be retained, if 
the first is thrown up. The diet should be unstim- 
ulating, and easy of digestion ; the drinks mucila- 
ginous or acidulated fluids, and taken in small quan- 
ties at a time. In cases where the disease assumes 
the typhoid form, bleeding is not recommended, but 
a more generous diet may be allowed, with beef 
tea, brandy or some other spirituous liquor. An 
acute attack of puerperal fever sometimes runs 
into the chronic form, and in some cases, the dis- 
ease comes on gradually, and assumes this form, at- 
tended with some of the symptoms previously men- 
tioned, though of a less aggravated character, and 
continuing several weeks ; this is frequently obser- 
ved after an abortion. 

Although general bleeding will rarely be of ser- 
vice in cases of this class, leeches are often of 
great advantage ; also frictions to the abdomen, 
with spirits of turpentine and sweet oil, or mercuri- 
al ointment, about one drachm, well rubbed in, twice 
or three times a day, and the remedies previously 
recommended to a greater or less extent, according 
to the severity of the symptoms. 

In this form of the complaint, it may terminate 
fatally, in consequence of its protracted course, and 
exhaustion of the vital forces from the violence of 
the constitutional disease. 



308 THIRTY YEARS OF FEMALE LIFE. 



CHAPTER XXX. 

CRURAL PHLEBITIS, OR MILK LEG. 

This disease is commonly called swelled leg, or 
milk leg, from the opinion, entertained in times past, 
that by some mysterious process, the milk was trans- 
ferred to the limb, causing it to swell. 

Crural phlebitis, signifies inflammation of the 
veins of the leg, which is the prominent feature of 
the complaint, commencing usually about a week 
after delivery ; in some cases, earlier, and in others, 
several weeks after the birth of the child. Al- 
though most frequently met with after delivery at 
full term, it sometimes succeeds abortion, and has 
been known tooccur, independent of conception and 
its consequences. 

"It consists in a swelling of one or both legs, 
(simultaneously or successively) shortly after deliv- 
ery, with pain and tenderness, and running a defi- 
nite course. The left leg is more frequently affect- 
ed than the right. It may occur with first children, 
but is more frequent after subsequent deliveries.''"^ 

" After one leg has been affected, and even before 
the complaint has completed its course there, the 
other may become diseased ; and this has no influ- 

* Churchill's Midwilery, page 512. 



THIRTY YEARS OF FEMALE LIFE. 309 

ence on the progress of the first. The second at- 
tack is sometimes the worse of the two, owing, per- 
haps, to the previous debility. Coldness is often 
felt in the second leg, before the paroxysm comes 
on, and pain in the belly precedes the attack. The 
first leg may be the second time attacked."^ 

Although rarely fatal, it is often tedious, the limb 
remaining swelled a long time, and the patient 
slowly recovering her strength ; the leg may also 
suppurate, or mortify, resulting in serious constitu- 
tional disturbance, exhaustion and death. 

Causes. — In many cases, the cause is very ob- 
scure, yet it is generally considered the effect of 
cold ; diseases of the womb may also give rise to it; 
of this there is little doubt, particularly in regard 
to inflammation of the womb or its appendages, 
which may previously exist, or occur in consequence 
of labor, and spread to the veins of the leg. 

Symptoms. — In many cases, the patient first com- 
plains of pain in the groin ; at other times, the pain 
is first felt in the calf of the leg, which sometimes 
comes on suddenly ; and not unfrequently the dis- 
ease is preceded by pain and tenderness of the low- 
er part of the abdomen, extending to the groin, and 
down the thigh and leg to the foot. The leg is very 
tender to the touch, soon begins to swell, and feels 
stiff and useless ; the veins are large and swollen, 
and more exquisitely tender than other portions of 
the limb ; the veins and glands about the groin are 

♦Burn's Midwifery, page 420. 



310 THIRTY YEARS OP FEMALE LIFE. 

enlarged, and very tender, "n some cases, the up- 
per extremities have been known to be similarly 
affected. 

'' Sometimes the disease begins like rheumatism, 
affecting the back and hip joint. Then the upper 
part of the thigh becomes painful and swelled, and 
next the calf of the leg suffers ; sometimes the limb 
at first feels colder than the other. Occasionally, 
the disease is very mild, and attended with little 
swelling. ^^^ 

In many cases, however, the limb becomes great- 
ly distended, being sometimes twice the size of the 
sound leg. The swelling generally begins within 
twenty-four hours after the pain commences, and 
frequently attains its largest dimensions within for- 
ty-eight hours. The leg is generally hot, but rare- 
ly red ; sometimes it feels colder, and looks paler 
than natural. The pulse is generally very quick, 
often a hundred and forty beats per minute, though 
weak and feeble ; the patient is restless and sleep- 
less ; complains of thirst ; the tongue is white and 
moist; the appetite is lost, the countenance pale, 
the bowels frequently constipated, and the stools 
clay colored ; sometimes there is a looseness of the 
bowels, the evacuations being very foetid and bil- 
ious ; the discharge from the womb, in some cases, 
is of very bad odor, or it may be suppressed ; gen- 
erally it is not much affected ; the urine is turbid, 
and the patient perspires freely. The pain,tJiough 

♦ Burns' Midwifery, page 419. 



THIRTY YEARS OF FEMALE LIFE. 311 

constant, is frequently aggravated from time to time, 
and when the swelling has reached its height, the 
pain is generally less than it was before this occurred. 
The disease may run its course in about two weeks ; 
in some cases, however, it assumes a chronic form, 
the limb remaining useless several months ; and 
sometimes the swelling never entirely leaves it. 

Treatment. — As the disease arises from inflam. 
mation of the veins of the leg, and is frequently 
associated with more or less inflammation of the 
organs and tissues within the pelvis, if the patient 
is of a plethoric habit, bleeding from the arm will 
sometimes be of service ; but it should be resorted 
to at the commencement of the attack, before the 
limb becomes swollen, or not at all. Whether gen- 
eral bleeding is resorted to or not, leeches will be 
of service, and the earlier they are applied, the 
more benefit there will be from them ; they should 
■ be applied to the groin, and limb where the pain 
and tenderness is most complained of, particularly 
along the course of the veins, and repeated several 
times if necessary ; also hot fomentations, as hot 
poultices, large enough to cover the limb, or flannel 
cloths wrung out of hot vinegar and water, hot 
camomile tea with camphor, and applied as hot as 
the patient can bear ; then wrap it up in a blanket 
or quilt, to retain the heat and moisture about the 
limb as long as possible ; these fomentations should 
be changed often, and continued several hours, the 
leg may then be rubbed with oil and laudanum, 
spirits of turpentine, or camphorated oil, and the 



312 THIRTY YEARS OF FEMALE LIFE. 

fomentations resorted to again, if the swelling con- 
tinues. Blisters do good in many cases ; for this 
purpose, a long strip of blister plaster, or several 
small plasters should be applied along the course of 
the veins. The state of the bowels will require 
special attention ; if they are constipated, give a 
dose of castor oil, or some other gentle cathartic, and 
when the stools are clay colored, small doses of 
calomel, or podophyllin and leptandrin, will have a 
good effect. Although very active purgatives, or 
profuse and frequent evacuations from the bjowels 
should be avoided, they must be kept regular by 
gentle aperients, such as extract of butternut, 
cream of tartar, epsom salts, and others of this 
class. If there is diarrhoea, restrain it, with chalk 
mixture and catechu, and other astringents. Opium 
in some form, hyoscyamus, or extract of hops, will 
be of service to quiet the restlessness, and procure 
sleep ; and if the discharge from the womb is of 
bad odor, injections up the front passage with warm 
milk and water, camomile tea, or a tea-spoonful of 
the chloride of soda solution, or chloride of limCj in 
half a tea-cupful of warm water, will correct it. 
The diet should be light, and unstimulating, during 
the stage of excitement, but as the disease contin- 
ues, tonics will be required to keep up the strength 
of the patient, such as Peruvian bark, quinine, and 
elixir of vitriol, and a more generous diet allowed, 
with ale, porter, or wine. Rest is a very important 
part of the treatment ; the limb should be moved 
as little as possible, as standing upon it, or walking 



THIRTY YEARS OF FEMALE LIFE. 813 

about too soon, frequently protracts the cure, and 
very often brings on another attack of the malady. 
The limb should be bandaged, from the foot to 
the groin, and gradually tightened, as the swelling 
is reduced ; the bandage will be a great support to 
the limb, and should be worn for a considerable 
time, after the patient is able to be about on her 
feet ; bathing the affected limb night and morning, 
in salt water, will be of service in imparting strength 
to it. 



CHAPTER XXXI. 

MILK FEVER. 

In a few hours after delivery, or not until the 
third day, the secretion of milk commences ; this is 
frequently attended with slight symptoms of fever, 
so mild however, that no special treatment is requir- 
ed in the generality of cases ; but not unfrequently, 
from improper diet, too much stimulus, constipation, 
or the effect of cold, the character of the malady is 
greatly aggravated, or entirely changed. The pa- 
tient complains of feeling cold, which increases to 
a decided ague chiU, with head-ache and pain in the 
back and limbs ; the chill may last but a few minutes, 
or continue two or three hours, followed by a hot 
stage, with throbbing of the temples, flushed face. 



314 THIRTY YEARS OF FEMALE LIFE. 

thirst, pain over the eyes, and in some cases pain 
and soreness of the abdomen ; and if the breasts 
are examined, they will generally be found tender 
to the touch. The hot stage is succeeded by pro- 
fuse perspiration, which usually brings great relief 
to the patient, and if properly treated, does not re- 
turn ; in some cases, however, through neglect, it 
runs into intermitting, or continued fever. During 
the attack, the pulse is quick and full, sometimes 
irregular or variable ; the discharge from the womb 
diminished in quantity, and when it occurs after the 
secretion of milk has taken place, this is frequently 
diminished also. In some cases, the fever runs high, 
attended with head symptoms, and delirium. There 
is frequently nausea or vomiting, the tongue is 
coated and the bowels constipated. 

Treatment. — During the cold stage, give hot 
drinks, and let the patient have bottles of hot water 
to her feet, and an extra amount of bed clothes ; 
care being taken that she do not take cold after the 
chill passes off, by removing too much of the bed 
clothes at a time. When the hot stage comes on, 
cold or cooling drinks may be given, a little at a 
time, and often if necessary ; the bowels should be 
freely evacuated by gentle cathartics and saline 
aperients, given from time to time, for the purpose 
of keeping up a regular action of the bowels. In 
some cases, bleeding from the arm will be of ser- 
vice, or leeches to the temples, and cold applications 
to the head. If there is nausea and vomiting, give 
a tea-spoonful of the compound spirits of lavender, 



THIRTY YEARS OF FEMALE LIFE. 315 

or thirty or forty drops of the ammoniated tincture 
of valerian, in a wine-glass of water ; or apply a 
mustard plaster over the stomach. Emetics do good 
in some cases, where the tongue is foul, and the pa- 
tient is sick at the stomach, and inclined to vomit. 
The abdomen should be carefully examined ; if pain- 
ful and tender to the touch, apply leeches, hot fo- 
mentations, or blisters, and give a full dose of opium, 
or Dover powder and camphor, or an injection up 
the rectum, of a tea-spoonful of laudanum, in half a 
tea-cupful of thin starch. The breasts require spe- 
cial attention ; if they are swollen and painful, they 
not unfrequently give rise to the fever, and if neg- 
lected, the patient is in great danger of having a 
broken breast. The diet should be light and unstim- 
ulating, and if the patient is restless and nervous, 
give five grains of Dover powder, and four grains of 
camphor, or a tea-spoonful of the ammoniated tinc- 
ture of valerian. Should the fever continue, or the 
attacks return every day, or every other day, tonics 
will be required, as quinine, in doses of two or three 
grains, Peruvian bark, and others, with wine or 
brandy, and a more generous diet. 



316 THIRTY YEARS OF FEMALE LIFE. 



CHAPTER XXXn. 

ABSCESS OF THE BREASTS. 

This complaint is commonly known by the term 
broken breast,and generally occurs a few days after 
delivery at fall term, or within the month ; sometimes 
it comes on when the child is weaned ; it may also 
occur after an abortion at the third or fourth month, 
and in some cases, independent of pregnancy. 

Causes. — The formation of matter is the effect of 
inflammation ; hence, whatever induces inflamma- 
tion of the breasts, may be considered the cause of 
the malady. When it occurs after delivery, it is 
sometimes the effect of cold, but more frequently 
through neglect, in allowing the breasts to become 
over-distended with milk ; this causes inflammation 
of the milk tubes, which spreads to other portions 
of the breast, and matter is formed. Sometimes 
the act of nursing is so very painful, in consequence 
of sore nipples, that the child is not allowed to 
draw out sufficient milk, to prevent the breasts 
from becoming over-distended ; or the nipples may 
be so small, that it is necessary to draw them out 
with the breast pump ; which process may cause ir- 
ritation of the nipples, and finally result in inflam- 
mation, and abscess of the breasts. It may also oc- 



THIKTY YEARS OF FEMALE LIFE. 317 

cur from moving the arms too much, soon after de- 
livery ; from taking cold at a menstrual period, and 
from injuries to the breasts by a blow or otherwise. 
Some women are subject to broken breasts after 
every confinement. 

Symptoms. — These will depend upon the extent of 
the inflammation, and whether deep-seated or not. 
If it attacks that portion of the breast near the sur- 
face, there is sometimes considerable fever, but the 
pain is not generally very severe ; the breast is 
redder than natural, feels hot, and is more or less 
swollen ; the secretion of milk may be arrested for 
a short time, but with gentle cathartic medicine 
poultices to the breasts, or friction with camphor- 
ated oil, and encouraging the flow of milk, the diffi- 
culty generally soon passes off ; but when the in- 
flammation is deep seated, affecting the glandular 
portion of the breast, the symptoms are greatly ag- 
gravated, and not unfrequently, proves a very seri- 
ous and sometimes fatal malady ; and under the 
most favorable circumstances, it is generally tedious, 
attended with intense suffering, and sometimes de- 
stroys the natural function of the breast, rendering 
it entirely useless. One breast only may be affect- 
ed, or both at the same time ; or after one has been 
sometime affected, the disease may attack the 
other also. When the inflammation is deep seated, 
the breast becomes greatly swollen, its whole sur- 
face red or mottled, the secretion of milk is arrested, 
or prevented from escaping ; there is a high fever, 
with headache, thirst, hot skin, quick pulse, an in- 



318 THIRTY YEARS OF FEMALE LIFE. 

tense throbbing pain in the breast, extending to 
the armpit, and very often the little glands there 
become inflamed, swollen and painful. Chills are 
often experienced when the formation of matter 
takes place, and after the breast has opened, the 
patient is sometimes subject to them from time to 
time. In many cases, the first indication of the 
malady, the patient is attacked with a severe chill, 
which after a longer or shorter period, passes off 
without any particular symptoms occurring for a 
day or two, and it may be longer, in some cases ; 
but if the breast is carefully examined soon after 
the chill, some portion of it will be found tender to 
the touch, and a hard lump will generally be detect- 
ed. This condition of the breast soon runs into ac- 
tive inflammation, and if not speedily subdued, mat- 
ter is formed, which sooner or later, finds its way to 
the surface, forming an opening or abscess ; some- 
times the matter forms several openings, and where 
the discharge of matter continues, as it does, in 
some cases, a long time, the general health becomes 
seriously affected, and, particularly in patients of a 
scrofulous habit, may terminate fatally. 

Treatment. — As the effect of inflammation is to 
form matter, this should be prevented, if possible, 
by reducing the inflammation. To accomplish this 
desirable result, the milk should be frequently drawn 
out, by nursing, or with the breast pump, and to 
assist the flow of milk, apply hot poultices to the 
breast, or rub it frequently with camphorated oil, 
volatile liniment, or apply a plaster of brown di- 



THIRTY YEARS OF FEMALE LIFE. 319 

achylon, large enough to cover the entire breast, 
leaving a hole in the centre for the nipple ; benefit 
is sometimes derived from bathing the breast with 
tincture of arnica, orthe sugar of lead wash, to Avhich 
a little laudanum may be added ; also cloths wet in 
hot camomile tea, with a table-spoonful of spirits of 
camphor to the half pint of the tea ; leeches ap- 
plied to the breast, will frequently be of service, 
and if there is much fever, bleeding from the arm 
may be required. The bowels should be freely 
evacuated at the commencement of the attack, and 
kept a little loose by cooling laxatives, as salts and 
senna, citrate of magnesia, and the like. Tartar 
emetic, often produces favorable results in this 
complaint, by the power it exerts over the inflam- 
mation ; it should be given in small doses, as a six- 
teenth, or eight of a grain, every two or three 
hours, just sufficient to cause nausea, but not vomi- 
ting ; when this occurs from its use, discontinue it 
until it is checked, when it can be again resorted 
to. If there is diarrhoea, or if this is produced by 
the tartar emetic, it should be checked with an 
occasional dose of opium, or some of the astringent 
preparations. If the treatment has not been com- 
menced in season, or in case the inflammation can- 
not be subdued, and the formation of matter is evi- 
dent, from the condition of the breast, hot poultices 
should be applied every two or three hours, to as- 
sist the suppurative process, and bring the matter 
forward as speedily as possible. A bread and milk 
poultice, answers the purpose very well, and if a 



320 THIRTY YEARS OF FEMALE LIFE. 

little laudanum, or tincture of lobelia is added to 
it, or tlie powdered lobelia sprinkled over the sur- 
face of the poultice, it will often greatly relieve the 
pain, and does not interfere with the action of the 
poultice. If matter is formed near the surface, it 
is generally as well to let it break of itself ; but 
when deep seated, it is best to lance it, for if left 
to break of itself, the matter is apt to burrow, 
forming sinuses or cavities, in different portions 
of the breast, which form several openings, dis- 
charging a long time, to the great annoyance 
of the patient, and often seriously affecting her 
general health. Whether the abscess is lanced, or 
allowed to break of itself, the breast will require 
poulticing for several days, to encourage the dis- 
charge of matter, and when this has continued a 
sufficient length of time, simple dressings are to be 
substituted, such as simple cerate, or an ointment 
made by melting together bees-wax and lard, or ap- 
ply a cloth smeared with sweet oil, or mutton tal- 
low. If the openings in the breast do not heal up 
readily, a solution, made by dissolving twenty 
grains of nitrate of silver, in an ounce of water, 
and applied to the edges of the ulcer with a camel- 
hair brush, or a small roll of fine linen, two or three 
times a week, will assist the healing process. To 
relieve the pain, and procure sleep, some narcotic 
will be required, as opium, laudanum, morphine, or 
Dover powder. If the abscess is small, nursing 
from the affected breast may sometimes be continu- 
ed, but when more extensive, and affecting both 



THIRTY YEARS OF FEMALE LIFE. 321 



breasts, the child should be weaned. The strength 
must be kept up by a generous diet, with Avine, or 
some of the preparations of iron, and other tonics. 



CHAPTER XXXm. 



TURN OF LIFE. 



For some thirty years of female life, the ova- 
ries perform their special function, resulting in 
the phenomenon of menstruation ; but when 
no longer required in the important process for 
which they were called into being, they cease 
to act, and menstruation ceases also. After the 
final cessation of this function, the ovaries and 
womb decrease in size, and finally assume a condi- 
tion, similar to that observed in early life, before 
the age of puberty. The time when the menstrual 
function ceases, is called the change, or turn of life, 
and usually occurs about the forty-fifth year ; it may, 
and often does continue until a much later period, 
many women continuing regular in their menstrua- 
tion until fifty, some sixty, and in a few anamolous 
cases, seventy years and upwards ; others again, 
cease to menstruate before they are thirty, without 
any untoward symptoms ; frequently, however, 
when the change occurs at the most common period, 
it is preceded, or attended, with considerable dis- 



322 THIRTY YEARS OF FEMALE LIFE4 

turbance of the system. The previous health of 
the woman, and her condition at the time the change 
takes place, affects it more or less. If she is 
healthy, the courses not unfrequently become gradu- 
ally less in quantity at each period, and assume a 
lighter color, until the show ceases altogether, un- 
attended with any particular symptoms ; this may 
be considered the natural or proper course. In 
other cases there is an interruption or suppression 
of the courses, for two or three periods at a time ; 
this may occur several times before it finally ceases, 
or the suppression may continue for a year, and in 
some cases longer, the show again appearing for a 
few periods, and then finally ceasing, and in some rare 
instances, the show has come on when the woman 
was far advanced in life, she having ceased to men- 
struate at the usual period. 

Leucorrhoea is not uncommon at this period, and 
some women are subject to it that were free from it 
previously. In some cases, when the change is 
about taking place, the patient is subject to frequent 
attacks of uterine hemorrhage, which is sometimes 
very profuse, unattended with much pain usually, 
but producing more or less prostration, from the ex- 
cessive loss of blood, and if oft repeated, the general 
health becomes seriously affected. These hemorr- 
hages extend over a period of several years, occur- 
ring, in some cases, at each monthly period ; or the 
discharge of blood may continue from one month 
to another, becoming less in quantity between the 
periods, and increased again, when the regular pe- 



THIRTY YEARS OP FEMALE LIFE. 323 

riod arrives. In other cases, there is an intermis- 
sion of the hemorrhage for several months, or it 
may not occur more than once or twice before the 
change is finally accomplished. As the health of 
the female previous to the second critical period, 
depends in a great measure, upon the natural and 
proper commencement of the menstrual function, so 
are the remaining years of her life, influenced 
by the mode of its final cessation ; any deviation, 
therefore, from a natural course, should be attended 
to, as diseases of a serious nature often manifest 
themselves at this eventful period. 

When we take into consideration the fact, that for 
many j^ears, the system has been subject to a peri- 
odical loss of blood, we should not be surprised to 
find more or less disturbance of the organism, when 
this discharge finally ceases ; or that the complaints 
to which the female had been subject, during the 
period of menstrual action, should exert at this 
time, an unfavorable influence ; or that diseases 
which have lain dormant in the system for years, 
should now declare themselves. At this period, 
cancer of the breast and womb are more frequently 
met with than at any other time ; and the healthy 
performance of the different functions of the organ- 
ism are also seriously affected, in many cases. 

The symptoms arising from the cessation of the 
menstrual function are numerous, and modified by 
the mode of its cessation, habits of life, and peculi" 
arities of the constitution. In many cases, the fe- 
male complains of headache, throbbing of the tern- 



324 THIRTY YEARS OF FEMALE LIFE. 

pies, flashes of heat, pain in the lower part of the 
abdomen, back, and other parts of the body, faint- 
ness, palpitation of the heart, difficulty of breathing, 
dizziness, confusion of ideas, and sometimes the 
mind becomes seriously and permanently affected. 
Attacks of hysteria, epilepsia, and apoplexia, are 
not uncommon ; the liver, also, is frequently affect- 
ed, becoming congested, torpid, or inactive, and as 
a consequence, the bowels are irregular, sometimes 
too loose, but more frequently constipated ; piles 
are also of frequent occurrence. The torpid condi- 
tion of the liver often induces bilious attacks, a sal- 
low complexion, drowsiness, variable appetite, 
nausea, and vomiting. The circulating and nervous 
systems become first affected, hence, the determina- 
tion of blood to the head, apoplexia, hysteria, ner- 
vous headache, and other nervous affections. 

If the female is of a full, plethoric habit, bleed- 
ing from the arm will be of great advantage, togeth- 
er with active cathartics, exercise in the open air, 
and a light, unstimulating di^t. After evacuating 
the bowels, they should be kept regular by cooling 
laxatives, such as epsom salts, sulphur and cream 
of tartar, citrate of magnesia, and others of this 
class. If she is subject to nervous attacks, and 
feels weak and exhausted, the compound spirits 
of lavender, camphor, ammoniated tincture of va- 
lerian, or two or three assafoetida pills, will be of 
service, together with a more generous diet, with 
bark and wine, some of the preparations of iron, 
and other tonics. 



THIRTY YEARS OF FEMALE LIFE. 325 

To quiet restlessness and procure sleep, the proper 
remedies should be resorted to, and in all cases, the 
condition of the bowels require special attention, as 
no class of remedies produce such favorable results, 
particularly at this period, as cathartics ; bleeding 
is of decided advantage in many cases, but even 
this important remedy may frequently be dispensed 
with, if the bowels are freely evacuated. Not that 
we expect or advise females to be constantly phys- 
icing with violent purgatives, but we wish to im- 
press upon them the importance of keeping up a 
regular action of the bowels, by the use of remedies 
capable of accomplishing this result. Much can 
be done in this respect by dieting ; the use of ripe 
and stewed fruits, and exercise in the open air ; 
which is necessary under any circumstances when 
the weather is favorable, and the female is in a con- 
dition to profit by it. The frequent use of injec. 
tions, cannot be too highly recommended ; in case 
of hemorrhage, this remedy produces favorable 
results ; if piles exists they are greatly relieved by 
them, and in many cases entirely cured ; and to 
relieve the over-loaded condition of the lower 
bowel, they are preferable to physic. In some 
cases, active cathartics will be of great service ; 
taken occasionally, as the nature of the case re- 
quires, they not only produce a favorable effect 
from their immediate action on the bowels, but 
they also relieve the inconvenience and distress 
arising from the over-loaded condition of the blood- 
vessels, and sometimes prevent an attack of apo- 



326 THIETY YEARS OF FEMALE LIFE. 

plexia, the result generally of too much blood, or 
imperfect circulation of the vital fluid. The con- 
dition of the liver requires attention also, as many- 
cases of obstinate constipation, and irregularity of 
the bowels, depend upon some abnormal condition 
of this important organ. 

As the cessation of the menstrual function some- 
times occupies several years before it is finally ac- 
complished, women generally attribute their com- 
plaints at this time, to the change that is working 
on them, and console themselves with the belief, 
that when the menstrual function ceases entirely, 
their difficulties will cease also ; and in many cases 
this does occur as anticipated, but unfortunately, it 
too frequently happens, that symptoms long com- 
plained of, and attributed to the effect of the change, 
by being neglected, or not understood, finally result 
in firmly establishing some serious disease. 

The change of life, has been aptly termed the 
second critical period ; and it is quite common for 
women, to look forward to tha final cessation of the 
menstrual function, with more or less apprehension; 
yet, notwithstanding many females pass through 
this trying ordeal with great suffering, and not 
unfrequently fall victims to serious, and sometimes 
fatal organic diseases, if they are physically pre- 
pared for the change, all apprehensions are ground- 
less. On the other hand, if the female has suffered 
during the former part of her life, from complaints 
common amongst females at the present day, or 
the final cessation of the courses occurs unnatural- 



THIRTY YEARS OF FEMALE LIFE. 327 

ly, or out of the usual course, the case demands 
serious attention. Not that every deviation from a 
natural course, or the majority of cases, portend 
serious abnormal action ; yet, in many cases of this 
description, diseases of a serious nature do occur 
at this eventful period, and women not unfrequent- 
ly, are compelled to sulBFer from the ravages of a 
disease, which, if rightly understood, and properly 
treated in season, would have yielded to the treat- 
ment. The importance of careful attention to the 
first appearances of abnormal action, at this most 
critical period of their lives, cannot be too strong 
impressed on the minds of females, if they would 
pass safely through this crisis. 

In the preceding chapters of this treatise, we 
have attempted to describe some of the principal, 
and most common diseases to which females are 
subject, with their causes, symptoms, and treatment; 
believing that a careful study of the dijBFerent sub- 
jects treated of, will enable them, by a timely re- 
course to proper remedies, to escape much suffering, 
and pass safely through the trying scenes of life. 



V 



INDEX. 

A 

TAGE. 

Abdomen, enlargement of . • 212 

A blood clot mistaken for the after-birth .... 272 

Abortion, or miscarriage 260 

Abrasion of the neck of the Womb 86 

Abscess of the Breasts 316 

Absence of motion of the Child 280 

'' " the Womb 24 

" " '' Ovaries 24 

Acid fluid, or mncous of the Vagina 21 

Adhesion of the Vaginal walls .24 

After-birth, or Placenta 201 

'' retained in the Womb 272 

Age of Puberty 14 

Amniotic fluid 201 

Anomalous cases 21 

Antiseptic properties of the Vaginal Mucous . . . . 22 

Anteflexion of the Womb 109 

Ante version of the Womb 110 

Appendages of the Womb 12 

Apoplectic Convulsions 296 

Assimilation 48 

Areola, or circle around the Nipples 15 

A quack medicine 19 

B 

Bark of the Cotton Plant Root 39 

Bearing down sensation 107 

Bleeding Piles 221 

Blind Piles 221 

Blighted Ovum 277 

Bony tumors of the Ovaries 178 

Bones of the Pelvis ........ 10 



330 INDEX. 

PAGE 

Broad Ligaments 12 

Broken Breasts 316 

Brow Ague 147 

Brown or yellowish spots on the face 233 

Burning sensation when passing water 66 

o 

Cancer of the Ovaries 178 

u u i: Yagina 185 

*' .'* '• Womb 89 

Cartilaginous tumors of the Ovaries 178 

Cessation of menstruation 321 

Changes in the Breasts 211 

Character of menstrual blood 21 

Catalepsia 142 

Change of Life . . 321 

Child-bed Fever 297 

Chlorosis, or green sickness ....... 44 

Chronic suppression of the courses . . , . . 33 

^' Ovarian inflammation 73 

Clitoris . . - 13 

Closure of the mouth of the Womb . .... 24 

Coccyx 10 

Cold hands and feet . , 62 

Conception 199 

Congestion and engorgement of the Womb . . . .78 

Convulsions . . . 286 

Corroding ulcer of the womb 101 

Cough 240 

Costiveness 218 

Counter irritation 77 

Crm-al Phlebitis . 308 

D 

Dark circle under the Eyes . ^ 35 

Delivery during sleep 258 

*^ without pain . . . . . , . 259 

Development of the FcEtus • 203 



INDEX. 331 

PAGE. 

Difficulty of breathing 237 

** passing water 115 

Diarrhoea , 220 

Discoloration of the skin 233 

Dropsy of the Womb 191 

Drowsiness , . 17 

Duration of Pregnancy 254 

Duty of Mothers to their Girls 18 

E 

Emmenagogues • . .35 

Embryo of about one month, natural size . . , . 204 

Enlargement of the Abdomen 212 

" *• Breasts 211 

Enlarged Veins 223 

Engorgement and Congestion of the Womb ... 78 

Ergot, or Spurred Rye 269 

Epileptic Convulsions 286 

Erosion of the neck of the Womb 86 

External Organs 13 

Extra Uterine Pregnancy 202 

F 

Fainting 236 

Falling of the Bladder 181 

^' *^ Rectum, or Back Passage .... 182 

" " Yagina, or Front Passage . . . 181 

*' " Womb 103 

Fallopian Tubes . 12 

False Conception 276 

" Mole , . . 278 

Feet and Legs, swelling of 49 

Female Organs 10 

Fibrous Tumors of the Ovaries 178 

'• " " Womb 157 

Final cessation of the Courses 321 

First appearance of Menstruation 21 

Fluttering of the Heart 236 



332 INDEX* 

FAGE. 

Forcing Medicines 20 

Form of the Womb 10 

Front Passage, or Vagina 11 

G 

Getting up too soon after Child-birth or Abortion . . 106 

Girls need advice • • • 18 

Granular Ulceration of the Womb 87 

H 

Hay Fever . . • 240 

Headache 241 

Heartburn 210 

Hereditary transmission of Disease . , . . . 92 

Hermaphrodite 14 

Hooper's Pills , . 39 

Hydatids 280 

Hydrometra, or Dropsy of the Womb . . . . 191 

Hymen 11 

Hysteria • . 141 

I 

Immoderate Sexual Indulgence 284 

Imperforate Hymen 24 

Impregnated when Insensible 257 

Impregnation 198 

Inflammation of the Breasts ..,.,. 316 

" " " Ovaries 73 

" " " Womb 81 

Inflammation of the veins of the leg . . , . • 308 

Injections into the Womb 69 

Influence of climate on menstruation 24 

Irritable uterus .134 

Internal organs . . , • . . . . .13 

Inward weakness, or leucorrhoea 64 

Itching of the external parts 66 

r, ci u y^^^a 187 

Inversion of the Womb • . 121 



INDEX. 888 

J 

Jaundice 232 

Johanna Southcott 249 

L 

Labia Majora 13 

*• Minora 13 

Leucorrhcea, or whites 64 

Longings 211 

M 

Mark of Virginity 12 

Marriage as a cure for painful menstruation ... 54 

Malignant tumors of the ovaries 178 

Melanic tumors of the Ovaries 178 

Menstruation 14 

" at one year old 21 

" during pregnancy 207 

" every twenty-eight days 23 

'^ while nursing 207 

Milk Fever 313 

Milk in the breasts 227 

Milk leg 308 

Miscarriage, or abortion 260 

Misplacements of the front passage 181 

'' " '' womb 102 

Moles 277 

Morning Sickness . 208 

Mons veneris • .... 13 

Monthly flow . , 14 

" •* prevented from escaping . . , . 12 

Motion of the child suspended 249 

Much suffering might be prevented 67 

Mucous polypi 157 

N 

Navel string, or umbilical cord ...... 201 

Night Sweats 50 

Non-malignant tumors of the Ovaries 177 



334 INDEX. 

o 

PAGE. 

Obstructed menstruation ... . . , , 24 

Oil of Savin ......... 20 

Offensive Discharge from the Womb 97 

Os Uteri, or Mouth of the Womb 12 

Ovaries 13 

Ovarian Dropsy 1G2 

*^ Inflammation . . , 72 

" Tumors 162 

" Pregnancy 201 

Over-Nursing . . 57 

Ovum of about two months . . . . . . 205 

" " " *' weeks, natural size .... 204 

P 

Pain in the back . . 51 

" " side 231 

" under the left breast • . 34 

Painful Menstruation 51 

Palpitation of the Heart 234 

Physometra, or Wind in the Womb . . . . 194 

Piles . . , 221 

Placenta, or After-birth .201 

Plugging the Yagina 59 

Polypus of the Womb . . . . . . . 148 

Pregnancy 198 

Prolapse of the Yagina,. or Front Passage . . . 181 

Protracted Gestation 251 

Pressure of the Womb on the bladder and rectum . . 106 

Profuse Menstruation 56 

Pruritus, or itching of the Yulva 187 

Puberty .14 

Puerperal Fever . 297 

'' Peritonitis . 297 

Puncturing the Womb 26 

Q 

Quantity of the Menstrual Flow . . . . . .22 

Queen Mary 247 

Quickening . . . . . , . . . , 247 



INDEX. 835 

R 

PAGB. 

Rape 70 

Rheumatism of the Womb 53 

Retention of the After-birth 266 

" " Urine , 117 

Reproduction 198 

Retroflexion of the Womb 112 

Retroversion << " 113 

Round Ligaments ........ 12 

Rupture of the Perineum 108 

s 

Sacrum '10 

Salivation, or spitting 230 

Servix, or neck of the Womb 61 

Sexual Enjoyment . - ..... 255 

Signs of Pregnancy 206 

Situation of the Womb , 11 

Size of the Ovaries 13 

'' " '' Womb 12 

Spine 11 

Stony tumors of the ovaries 178 

Strange longings . . . 50 

St. Vitus Dance 50 

Sterility 283 

Suspicion of Pregnancy 52 

Swellings of the feet and legs 225 

Swelled leg 308 

Symptoms of Pregnancy . . . . . . . 206 

T 

Tardy sexual development 27 

Teeth found in ovarian tumors . . ^ . . . 166 

The bladder 11 

The female organs 10 

The hymen 11 

The pelvis 10 

The rectum 11 

The vagina, or front passage 11 



336 INDEX. 

PAGE. 

The womb, or uterus 11 

The womb turned inside out 121 

Thighbones 11 

Three weeks without food • . . . • . .343 

Tincture of Iron . . . 37 

Toothache 233 

Torpid liver 60 

Trance 142 

Tubal Pregnancy ........ 202 

Tubercular tumors of the ovaries 178 

Tumors of the vagina, or front passage . . . .184 

a u u Womb 148 

Turn of Life 321 

u 

Ulceration of the Womb ....... SQ 

Umbilical cord, or navel string 201 

Uterine hemorrhage ........ 61 

" leucorrhoea 65 

Uterus, or Womb «... 11 

V 

Tagina, or front passage . . . . , . . 11 

Vaginal leucorrhoea ^ . . .65 

Vascular tumor of the water passage . . . , 185 

Ventral Pregnancy ...... . . 202 

Viability 252 

Violent exercise during Menstruation 106 

w 

When most liable to become pregnant .... 245 

Whites, or inward weakness 64 

Weight of the Womb 12 

Wind in the Womb 194 

Womb, or uterus 11 

Y 

Yellowness of the skin 232 

Young girls subject to the Whites 70 



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